{"id":"F2001B00101","name":"Australian Industrial Relations Commission Rules 1998","slug":"australian-industrial-relations-commission-rules-1998","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"repealed","isInForce":false,"actNumber":"1 of 1998","makingDate":null,"administeringDepartment":null,"currentVersion":{"id":30940,"registerId":"commonwealth-F2001B00101-current","compilationNumber":null,"startDate":"2026-04-01","status":"Repealed","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"Receipt Number _________________________","sectionType":"schedule","heading":"Receipt Number __________________________/Credit Transaction","content":"Commission Use Only\n\n## Receipt Number \\_\\_\\_\\_\\_\\_\\_\\_\\_\\_\\_\\_\\_\\_\\_\\_\\_\\_\\_\\_\\_\\_\\_\\_\\_\\_/Credit Transaction\n\n## Processed\\_\\_\\_\\_\\_\\_\\_\\_\\_\\_\\_\\_\\_\\_\\_\\_\\_\\_\\_","sortOrder":0},{"sectionNumber":"Processed___________________","sectionType":"schedule","heading":"Processed___________________","content":"Commission Use Only\n\n## Receipt Number \\_\\_\\_\\_\\_\\_\\_\\_\\_\\_\\_\\_\\_\\_\\_\\_\\_\\_\\_\\_\\_\\_\\_\\_\\_\\_/Credit Transaction\n\n## Processed\\_\\_\\_\\_\\_\\_\\_\\_\\_\\_\\_\\_\\_\\_\\_\\_\\_\\_\\_","sortOrder":1},{"sectionNumber":"AUSTRALIAN INDUSTRIAL RELATIONS COMMISSI","sectionType":"schedule","heading":"AUSTRALIAN INDUSTRIAL RELATIONS COMMISSION","content":"Form R19 Application for relief in respect of termination of employment\n\n(rule 37)\n\n```html\n<table cellspacing=\"0\" cellpadding=\"0\" style=\"border-collapse:collapse\"><tbody><tr><td style=\"width:234.6pt; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.03pt; vertical-align:top\"><p style=\"margin-top:3pt; margin-bottom:9pt; font-size:10pt\"><span style=\"font-family:Arial, sans-serif\">Australian Industrial Relations Commission</span></p><p class=\"FormHeading\" style=\"margin-top:9pt; text-align:left; font-size:10pt\"><span>Application for relief in respect of termination of employment</span></p></td><td style=\"width:103.2pt; border:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top\"><p style=\"margin-top:3pt; margin-right:0.3pt; margin-bottom:3pt; font-size:10pt\"><span style=\"font-family:Arial, sans-serif\">Commission use only</span></p><p style=\"margin-top:3pt; font-size:10pt\"><span style=\"font-family:Arial, sans-serif\">file number</span></p></td></tr><tr><td style=\"width:234.6pt; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.03pt; vertical-align:top\"><p style=\"margin-top:3pt; margin-bottom:6pt; font-size:10pt\"><span style=\"font-family:Arial, sans-serif; font-style:italic\">Workplace Relations Act 1996</span><span style=\"font-family:Arial, sans-serif\"> (Cth)</span></p><p style=\"margin-top:6pt; margin-bottom:3pt; font-size:10pt\"><span style=\"font-family:Arial, sans-serif\">Subsection</span><span style=\"font-family:Arial, sans-serif\"> </span><span style=\"font-family:Arial, sans-serif\">170CE</span><span style=\"font-family:Arial, sans-serif\"> </span><span style=\"font-family:Arial, sans-serif\">(2) or (4)</span></p></td><td style=\"width:103.2pt; border:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top\"><p style=\"margin-top:3pt; font-size:10pt\"><span style=\"font-family:Arial, sans-serif\">date received</span></p></td></tr><tr><td colspan=\"2\" style=\"width:348.6pt; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top\"><p style=\"font-size:10pt\"><span style=\"font-weight:bold\">This Form is to be completed in respect of an application to the Commission for relief in respect of termination of employment solely on the ground of an alleged contravention of section</span><span style=\"font-weight:bold\"> </span><span style=\"font-weight:bold\">170CL of the</span><span style=\"font-weight:bold; font-style:italic\"> Workplace Relations Act 1996.</span></p><p><span></span></p><p style=\"margin-right:93.85pt; margin-bottom:6pt; font-size:10pt\"><span style=\"font-family:Arial, sans-serif\">Section 170CL states:</span></p><p class=\"R1\" style=\"margin-bottom:6pt\"><span style=\"width:23.6pt; text-indent:0pt; font-size:10pt; display:inline-block\"></span><span style=\"font-size:10pt\">“(1)</span><span style=\"width:8.5pt; text-indent:0pt; font-size:10pt; display:inline-block\"> </span><span style=\"font-size:10pt\">This section applies if an employer decides to terminate the employment of 15 or more employees for reasons of an economic, technological, structural or similar nature, or for reasons including such reasons.</span></p><p class=\"R1\" style=\"margin-bottom:3pt\"><span style=\"width:28.04pt; text-indent:0pt; font-size:10pt; display:inline-block\"></span><span style=\"font-size:10pt\">(2)</span><span style=\"width:8.5pt; text-indent:0pt; font-size:10pt; display:inline-block\"> </span><span style=\"font-size:10pt\">As soon as practicable after so deciding and before terminating an employee’s employment because of the decision, the employer must give to the body (if any) prescribed by regulations made for this subsection or, failing the prescription of such a body, to the Secretary of the Department, a written notice of the intended terminations, in a form prescribed by the regulations, that sets out:</span></p><p class=\"P1\" style=\"margin-bottom:3pt\"><span style=\"font-size:10pt\"></span><span style=\"width:45.95pt; text-indent:0pt; font-size:10pt; display:inline-block\"></span><span style=\"font-size:10pt\">(a)</span><span style=\"width:11.35pt; text-indent:0pt; font-size:10pt; display:inline-block\"> </span><span style=\"font-size:10pt\">the reasons for the terminations; and</span></p><p class=\"P1\" style=\"margin-bottom:3pt\"><span style=\"width:47.89pt; text-indent:0pt; font-size:10pt; display:inline-block\"></span><span style=\"font-size:10pt\">(b)</span><span style=\"width:11.35pt; text-indent:0pt; font-size:10pt; display:inline-block\"> </span><span style=\"font-size:10pt\">the number and categories of employees likely to be affected; and</span></p><p class=\"P1\" style=\"margin-bottom:3pt\"><span style=\"width:48.45pt; text-indent:0pt; font-size:10pt; display:inline-block\"></span><span style=\"font-size:10pt\">(c)</span><span style=\"width:11.35pt; text-indent:0pt; font-size:10pt; display:inline-block\"> </span><span style=\"font-size:10pt\">the time when, or the period over which, the employer intends to carry out the terminations.</span></p><p class=\"P1\"><span style=\"width:47.89pt; text-indent:0pt; font-size:10pt; display:inline-block\"></span><span style=\"font-size:10pt\">(3)</span><span style=\"width:11.35pt; text-indent:0pt; font-size:10pt; display:inline-block\"> </span><span style=\"font-size:10pt\">The employer must not terminate an employee’s employment pursuant to the decision unless the employer has complied with subsection (2).”.</span></p></td></tr></tbody></table>\n```\n\n  \nIn making this claim you (the applicant) should be aware that:\n\n-   specified categories of employees are excluded from making a claim under the Termination of Employment provisions of the Workplace Relations Act 1996.\n-   an application lodged more than 21 days after the day on which the employee is given notice of the decision to terminate the employee’s employment can only be accepted if the Commission decides it would be unfair not to do so.\n-   section 170CJ of the Workplace Relations Act 1996 allows, in certain circumstances, the Commission to make an order for costs\n-   Section 170CEAA of the Workplace Relations Act 1996 requires a fee of $52.40 to be paid on lodgment of this application in the Commission unless a Registrar has approved the waiving of the fee. The $52.40 lodgment fee is refundable under certain circumstances\n\nDetails in relation to these matters are available from the Industrial Registry.\n\n```html\n<table cellspacing=\"0\" cellpadding=\"0\" style=\"border-collapse:collapse\"><tbody><tr><td colspan=\"7\" style=\"width:348.6pt; border:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top; background-color:#e5e5e5\"><p style=\"margin-top:3pt; page-break-after:avoid; font-size:10pt\"><span style=\"font-family:Arial, sans-serif; font-weight:bold\">Details of employer alleged to have contravened section 170CL</span></p></td></tr><tr><td colspan=\"2\" style=\"width:129.3pt; border:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top\"><p style=\"margin:3pt 1.15pt 15pt 17pt; text-indent:-17pt; page-break-after:avoid; font-size:10pt\"><span style=\"font-family:Arial, sans-serif\">1</span><span style=\"width:11.44pt; text-indent:0pt; font-family:Arial, sans-serif; display:inline-block\"> </span><span style=\"font-family:Arial, sans-serif\">employer’s name</span></p><p style=\"margin-top:15pt; margin-right:1.15pt; margin-left:17pt; text-indent:-17pt; page-break-after:avoid; font-size:10pt\"><span style=\"width:17pt; text-indent:0pt; font-family:Arial, sans-serif; display:inline-block\"></span><span style=\"font-family:Arial, sans-serif\">contact person</span></p></td><td colspan=\"5\" style=\"width:208.5pt; border:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top\"><p style=\"margin-top:3pt; margin-left:151.1pt; margin-bottom:15pt; text-indent:-151.1pt; page-break-after:avoid; font-size:10pt\"><span style=\"font-family:Arial, sans-serif\">……………………………………………………</span></p><p style=\"margin-top:15pt; margin-left:151.1pt; text-indent:-151.1pt; page-break-after:avoid; font-size:10pt\"><span style=\"font-family:Arial, sans-serif\">……………………………………………………</span></p></td></tr><tr><td colspan=\"2\" style=\"width:129.3pt; border:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top\"><p style=\"margin-top:3pt; margin-right:1.15pt; margin-left:17pt; text-indent:-17pt; font-size:10pt\"><span style=\"font-family:Arial, sans-serif\">2</span><span style=\"width:11.44pt; text-indent:0pt; font-family:Arial, sans-serif; display:inline-block\"> </span><span style=\"font-family:Arial, sans-serif\">employer’s trading address or registered office</span></p></td><td colspan=\"5\" style=\"width:208.5pt; border:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top\"><p style=\"margin-top:12pt; margin-left:151.1pt; margin-bottom:3pt; text-indent:-148.85pt; font-size:10pt\"><span style=\"font-family:Arial, sans-serif\">……………………………………………………</span></p><p style=\"margin-top:3pt; margin-left:151.1pt; margin-bottom:3pt; text-indent:-148.9pt; font-size:10pt\"><span style=\"font-family:Arial, sans-serif\">…………………………………………… ……..</span></p><p style=\"margin-top:3pt; margin-left:115.25pt; margin-bottom:3pt; text-indent:-113.05pt; font-size:10pt\"><span style=\"font-family:Arial, sans-serif\">…………………………… Postcode …………</span></p><p style=\"margin-top:3pt; margin-left:151.1pt; text-indent:-148.85pt; font-size:10pt\"><span style=\"font-family:Arial, sans-serif\">phone (….) ………………… Fax (….) ………</span></p></td></tr><tr><td colspan=\"2\" style=\"width:129.3pt; border:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top\"><p style=\"margin-top:3pt; margin-right:1.15pt; margin-left:17pt; text-indent:-17pt; font-size:10pt\"><span style=\"font-family:Arial, sans-serif\">3</span><span style=\"width:11.44pt; text-indent:0pt; font-family:Arial, sans-serif; display:inline-block\"> </span><span style=\"font-family:Arial, sans-serif\">date notice of decision to terminate employee’s employment was given.</span></p></td><td colspan=\"5\" style=\"width:208.5pt; border:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top\"><p style=\"margin-top:18pt; margin-left:151.1pt; margin-bottom:3pt; text-indent:-148.85pt; font-size:10pt\"><span style=\"width:42.15pt; text-indent:0pt; font-family:Arial, sans-serif; font-weight:bold; display:inline-block\"></span><span style=\"font-family:Arial, sans-serif; font-weight:bold\">/</span><span style=\"width:39.72pt; text-indent:0pt; font-family:Arial, sans-serif; font-weight:bold; display:inline-block\"> </span><span style=\"font-family:Arial, sans-serif; font-weight:bold\">/</span></p><p style=\"margin-top:3pt; margin-left:151.1pt; text-indent:-148.9pt; font-size:10pt\"><span style=\"font-family:Arial, sans-serif\"></span></p></td></tr><tr><td colspan=\"2\" style=\"width:129.3pt; border:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top\"><p style=\"margin-top:3pt; margin-right:1.15pt; margin-left:17pt; text-indent:-17pt; font-size:10pt\"><span style=\"font-family:Arial, sans-serif\">4</span><span style=\"width:11.44pt; text-indent:0pt; font-family:Arial, sans-serif; font-weight:bold; display:inline-block\"> </span><span style=\"font-family:Arial, sans-serif\">other employment details</span></p></td><td colspan=\"5\" style=\"width:208.5pt; border:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top\"><p class=\"BodyTextIndent\" style=\"margin-top:3pt; margin-left:0pt; font-size:10pt\"><span style=\"font-family:Arial, sans-serif\">State the name of the award or agreement (including Australian Workplace Agreement) under which the employees are*/ were employed</span></p><p class=\"BodyTextIndent\" style=\"margin-top:6pt; margin-left:0pt; font-size:10pt\"><span style=\"font-family:Arial, sans-serif\">……………………………………………………</span></p></td></tr><tr><td colspan=\"2\" style=\"width:129.3pt; border:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top\"><p style=\"margin-top:3pt; margin-right:1.15pt; margin-left:17pt; text-indent:-17pt; font-size:10pt\"><span style=\"font-family:Arial, sans-serif\"></span></p></td><td colspan=\"5\" style=\"width:208.5pt; border:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top\"><p style=\"margin-top:3pt; margin-left:1.7pt; margin-bottom:3pt; text-indent:0.55pt; font-size:10pt\"><span style=\"font-family:Arial, sans-serif\">State whether the award or agreement is State or Federal</span></p><p style=\"margin-top:3pt; margin-left:22.95pt; margin-bottom:3pt; text-indent:-20.75pt; font-size:10pt\"><span style=\"font-family:Wingdings, serif\"></span><span style=\"width:11.84pt; text-indent:0pt; font-family:Arial, sans-serif; display:inline-block\"> </span><span style=\"font-family:Arial, sans-serif\">Federal</span></p><p style=\"margin-top:3pt; margin-left:22.95pt; text-indent:-20.75pt; font-size:10pt\"><span style=\"font-family:Wingdings, serif\"></span><span style=\"width:11.84pt; text-indent:0pt; font-family:Arial, sans-serif; display:inline-block\"> </span><span style=\"font-family:Arial, sans-serif\">State If State, name of State: …………</span></p></td></tr><tr><td colspan=\"7\" style=\"width:348.6pt; border:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top; background-color:#d8d8d8\"><p style=\"margin-left:17pt; text-indent:-17pt; page-break-after:avoid; font-size:10pt\"><span style=\"font-family:Arial, sans-serif\">5</span><span style=\"width:11.44pt; text-indent:0pt; font-family:Arial, sans-serif; font-weight:bold; display:inline-block\"> </span><span style=\"font-family:Arial, sans-serif; font-weight:bold\">About the employees</span></p></td></tr><tr><td colspan=\"7\" style=\"width:348.6pt; border:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top\"><p class=\"BodyText\" style=\"margin-bottom:18pt; font-size:10pt\"><span style=\"font-family:Arial, sans-serif\">Here insert name and address of employee/s whose employment has been* / is proposed to be* terminated by the employer</span></p><p style=\"margin-top:18pt; font-size:10pt\"><span style=\"font-family:Arial, sans-serif\">…………………………………………………………………………………………</span></p><p style=\"font-size:10pt\"><span style=\"font-family:Arial, sans-serif\">…………………………………………………………………………………………</span></p><p style=\"font-size:10pt\"><span style=\"font-family:Arial, sans-serif\">…………………………………………………………………………………………</span></p><p style=\"font-size:10pt\"><span style=\"font-family:Arial, sans-serif\"></span></p></td></tr><tr><td colspan=\"7\" style=\"width:348.6pt; border:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top\"><p style=\"margin-top:3pt; margin-left:17pt; text-indent:-17pt; font-size:10pt\"><span style=\"font-family:Arial, sans-serif\">6</span><span style=\"width:11.44pt; text-indent:0pt; font-family:Arial, sans-serif; font-weight:bold; display:inline-block\"> </span><span style=\"font-family:Arial, sans-serif; font-weight:bold\">Brief summary of reasons given for termination or threatened termination</span><br><span style=\"font-family:Arial, sans-serif; font-style:italic\">(or attached)</span></p><p class=\"BodyText\" style=\"font-size:10pt\"><span style=\"font-family:Arial, sans-serif\">…………………………………………………………………………………………</span></p><p style=\"margin-top:6pt; font-size:10pt\"><span style=\"font-family:Arial, sans-serif\">…………………………………………………………………………………………</span></p><p class=\"DefaultParagraphFont1\" style=\"font-size:10pt\"><span style=\"font-family:Arial, sans-serif\">…………………………………………………………………………………………</span></p><p style=\"font-size:10pt\"><span style=\"font-family:Arial, sans-serif\">…………………………………………………………………………………………</span></p></td></tr><tr><td colspan=\"7\" style=\"width:348.6pt; border:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top; background-color:#e5e5e5\"><p style=\"page-break-after:avoid; font-size:10pt\"><span style=\"font-family:Arial, sans-serif; font-weight:bold\">Extension of Time</span></p></td></tr><tr><td colspan=\"7\" style=\"width:348.6pt; border:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top\"><p style=\"font-size:10pt\"><span style=\"font-family:Arial, sans-serif\"></span></p><p style=\"text-align:justify; font-size:10pt\"><span style=\"font-family:Arial, sans-serif\">7</span><span style=\"width:30.44pt; font-family:Arial, sans-serif; display:inline-block\"> </span><span style=\"font-family:Arial, sans-serif\">This section to be completed if the application is lodged more than 21 days after the day on which the employee is given notice of the decision to terminate the employee’s employment (see Item 3 above). In such cases, the Commission must decide whether to accept the application. My reason/s for seeking an extension of time to lodge this application is/are:</span><span style=\"font-family:Arial, sans-serif; font-style:italic\">(or attached)</span></p><p style=\"font-size:10pt\"><span style=\"font-family:Arial, sans-serif; font-style:italic\"></span></p><p style=\"font-size:10pt\"><span style=\"font-family:Arial, sans-serif\"></span></p></td></tr><tr><td colspan=\"7\" style=\"width:348.6pt; border:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top; background-color:#e5e5e5\"><p style=\"page-break-after:avoid; font-size:10pt\"><a id=\"_Toc108855926\"><span style=\"font-family:Arial, sans-serif; font-weight:bold\">Details of Union</span></a></p></td></tr><tr><td colspan=\"3\" style=\"width:135.8pt; border:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top\"><p style=\"margin-top:3pt; margin-left:17pt; margin-bottom:6pt; text-indent:-17pt; font-size:10pt\"><span style=\"font-family:Arial, sans-serif\">8</span><span style=\"width:11.44pt; text-indent:0pt; font-family:Arial, sans-serif; display:inline-block\"> </span><span style=\"font-family:Arial, sans-serif\">Is your union acting on your behalf</span></p></td><td colspan=\"4\" style=\"width:202pt; border:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top\"><p style=\"font-size:10pt\"><span style=\"font-family:Arial, sans-serif\">No </span><span style=\"font-family:Wingdings, serif\"></span><span style=\"font-family:Arial, sans-serif\"> go to 11</span></p><p style=\"font-size:10pt\"><span style=\"font-family:Arial, sans-serif\">Yes </span><span style=\"font-family:Wingdings, serif\"></span><span style=\"font-family:Arial, sans-serif\"> go to 9</span></p></td></tr><tr><td colspan=\"3\" style=\"width:135.8pt; border:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top\"><p style=\"margin-top:3pt; margin-left:17pt; margin-bottom:6pt; text-indent:-17pt; font-size:10pt\"><span style=\"font-family:Arial, sans-serif\">9</span><span style=\"width:11.44pt; text-indent:0pt; font-family:Arial, sans-serif; display:inline-block\"> </span><span style=\"font-family:Arial, sans-serif\">name and address of union</span></p></td><td colspan=\"4\" style=\"width:202pt; border:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top\"><p style=\"margin-top:12pt; font-size:10pt\"><span style=\"font-family:Arial, sans-serif\">……………………………………………………</span></p><p style=\"font-size:10pt\"><span style=\"font-family:Arial, sans-serif\">……………………………………………………</span></p><p style=\"font-size:10pt\"><span style=\"font-family:Arial, sans-serif\">……………………….. Postcode</span></p></td></tr><tr><td colspan=\"3\" style=\"width:135.8pt; border:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top\"><p style=\"margin-top:3pt; margin-left:17pt; text-indent:-17pt; font-size:10pt\"><span style=\"font-family:Arial, sans-serif\">10</span><span style=\"width:5.88pt; text-indent:0pt; font-family:Arial, sans-serif; display:inline-block\"> </span><span style=\"font-family:Arial, sans-serif\">union contact person</span></p></td><td colspan=\"4\" style=\"width:202pt; border:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top\"><p class=\"BodyText\" style=\"margin-top:12pt; font-size:10pt\"><span style=\"font-family:Arial, sans-serif\">……………………………………………………</span></p><p style=\"margin-top:6pt; font-size:10pt\"><span style=\"font-family:Arial, sans-serif\">phone (…..) …………… Fax (…..) …………</span></p></td></tr><tr><td colspan=\"7\" style=\"width:348.6pt; border:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top; background-color:#e5e5e5\"><p style=\"page-break-after:avoid; font-size:10pt\"><span style=\"font-family:Arial, sans-serif; font-weight:bold\">Details of representative</span></p></td></tr><tr><td colspan=\"3\" style=\"width:135.8pt; border:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top\"><p style=\"margin-top:3pt; margin-left:17pt; margin-bottom:6pt; text-indent:-17pt; font-size:10pt\"><span style=\"font-family:Arial, sans-serif\">11</span><span style=\"width:5.88pt; text-indent:0pt; font-family:Arial, sans-serif; display:inline-block\"> </span><span style=\"font-family:Arial, sans-serif\">Is anyone representing you?</span></p></td><td colspan=\"4\" style=\"width:202pt; border:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top\"><p style=\"font-size:10pt\"><span style=\"font-family:Arial, sans-serif\">No </span><span style=\"font-family:Wingdings, serif\"></span><span style=\"font-family:Arial, sans-serif\"> go to 15</span></p><p style=\"font-size:10pt\"><span style=\"font-family:Arial, sans-serif\">Yes </span><span style=\"font-family:Wingdings, serif\"></span><span style=\"font-family:Arial, sans-serif\"> go to 12</span></p></td></tr><tr><td colspan=\"3\" style=\"width:135.8pt; border:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top\"><p style=\"margin-top:3pt; margin-left:17pt; margin-bottom:6pt; text-indent:-17pt; font-size:10pt\"><span style=\"font-family:Arial, sans-serif\">12</span><span style=\"width:5.88pt; text-indent:0pt; font-family:Arial, sans-serif; display:inline-block\"> </span><span style=\"font-family:Arial, sans-serif\">name of solicitor or representative’s firm</span></p></td><td colspan=\"4\" style=\"width:202pt; border:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top\"><p style=\"font-size:10pt\"><span style=\"font-family:Arial, sans-serif\"></span></p></td></tr><tr><td colspan=\"3\" style=\"width:135.8pt; border:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top\"><p style=\"margin-top:3pt; margin-left:17pt; margin-bottom:6pt; text-indent:-17pt; font-size:10pt\"><span style=\"font-family:Arial, sans-serif\">13</span><span style=\"width:5.88pt; text-indent:0pt; font-family:Arial, sans-serif; display:inline-block\"> </span><span style=\"font-family:Arial, sans-serif\">name of contact person</span></p></td><td colspan=\"4\" style=\"width:202pt; border:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top\"><p style=\"font-size:10pt\"><span style=\"font-family:Arial, sans-serif\"></span></p></td></tr><tr><td colspan=\"3\" style=\"width:135.8pt; border:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top\"><p style=\"margin-top:3pt; margin-left:17pt; margin-bottom:6pt; text-indent:-17pt; font-size:10pt\"><span style=\"font-family:Arial, sans-serif\">14</span><span style=\"width:5.88pt; text-indent:0pt; font-family:Arial, sans-serif; display:inline-block\"> </span><span style=\"font-family:Arial, sans-serif\">address</span></p></td><td colspan=\"4\" style=\"width:202pt; border:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top\"><p style=\"margin-top:12pt; margin-left:151.1pt; margin-bottom:3pt; text-indent:-148.85pt; font-size:10pt\"><span style=\"font-family:Arial, sans-serif\">…………………………………………………</span></p><p style=\"margin-top:3pt; margin-left:151.1pt; margin-bottom:3pt; text-indent:-148.9pt; font-size:10pt\"><span style=\"font-family:Arial, sans-serif\">…………………………………………… ……..</span></p><p style=\"margin-top:3pt; margin-left:115.25pt; margin-bottom:3pt; text-indent:-113.05pt; font-size:10pt\"><span style=\"font-family:Arial, sans-serif\">………………………… Postcode …………</span></p><p style=\"margin-top:3pt; margin-left:151.1pt; text-indent:-148.85pt; font-size:10pt\"><span style=\"font-family:Arial, sans-serif\">phone (….) ………………… Fax (….) ………</span></p></td></tr><tr><td colspan=\"7\" style=\"width:348.6pt; border:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top; background-color:#e5e5e5\"><p style=\"margin-top:3pt; margin-bottom:2pt; page-break-after:avoid; font-size:10pt\"><span style=\"font-family:Arial, sans-serif; font-weight:bold\">Notices from the Commission</span></p></td></tr><tr><td style=\"width:115.1pt; border:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top\"><p style=\"margin-top:3pt; margin-left:17pt; margin-bottom:3pt; text-indent:-17pt; font-size:10pt\"><span style=\"font-family:Arial, sans-serif\">15</span><span style=\"width:5.88pt; text-indent:0pt; font-family:Arial, sans-serif; display:inline-block\"> </span><span style=\"font-family:Arial, sans-serif\">Where do you want notices from the Commission sent?</span></p><p style=\"margin-top:3pt; margin-left:14.2pt; text-indent:-14.2pt; font-size:10pt\"><span style=\"width:14.2pt; text-indent:0pt; font-family:Arial, sans-serif; display:inline-block\"></span><span style=\"font-family:Arial, sans-serif\">(choose one only)</span></p></td><td colspan=\"4\" style=\"width:74.25pt; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.03pt; vertical-align:top\"><p style=\"margin-top:3pt; font-size:10pt\"><span style=\"font-family:Arial, sans-serif\">address in 5 </span><span style=\"font-family:Wingdings, serif\"></span></p><p style=\"font-size:10pt\"><span style=\"font-family:Arial, sans-serif\"></span></p></td><td style=\"width:67.15pt; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top\"><p style=\"margin-top:3pt; font-size:10pt\"><span style=\"font-family:Arial, sans-serif\">union in 9 </span><span style=\"font-family:Wingdings, serif\"></span></p></td><td style=\"width:59.7pt; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.4pt; vertical-align:top\"><p style=\"margin-top:3pt; border-right:0.75pt solid #000000; padding-right:4pt; font-size:10pt\"><span style=\"font-family:Arial, sans-serif\">other in 12 </span><span style=\"font-family:Wingdings, serif\"></span><span style=\"font-family:Arial, sans-serif\"> give details</span></p><p style=\"font-size:10pt\"><span style=\"font-family:Arial, sans-serif\"></span></p></td></tr><tr><td colspan=\"7\" style=\"width:348.6pt; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top; background-color:#e5e5e5\"><p style=\"margin-top:3pt; margin-bottom:2pt; page-break-before:always\"><span style=\"font-family:Arial, sans-serif; font-size:10pt; font-weight:bold\">Declaration</span></p></td></tr><tr><td colspan=\"7\" style=\"width:348.6pt; border-top:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top\"><p style=\"margin-bottom:6pt; text-align:justify; font-size:10pt\"><span style=\"font-family:Arial, sans-serif; font-weight:bold\"></span></p><p style=\"margin-top:6pt; margin-bottom:6pt; text-align:justify; font-size:10pt\"><span style=\"height:0pt; margin-top:-6pt; text-align:left; display:block; position:relative; z-index:1\"><img src=\"image.003.png\" width=\"2\" height=\"2\" alt=\"\" style=\"margin-top:-40.3pt; margin-left:122.6pt; position:absolute\"></span><span style=\"font-family:Arial, sans-serif; font-weight:bold\">I declare that no proceedings in respect of the termination that is the subject of this claim have been commenced (other than proceedings that have since been discontinued or failed for want of jurisdiction) in respect of or on behalf of the employee under any other provision of the </span><span style=\"font-family:Arial, sans-serif; font-weight:bold; font-style:italic\">Workplace Relations Act 1996</span><span style=\"font-family:Arial, sans-serif; font-weight:bold\"> or under any other law of the Commonwealth or of a State or Territory.</span></p><p style=\"margin-top:6pt; margin-bottom:6pt; text-align:justify; font-size:10pt\"><span style=\"font-family:Arial, sans-serif; font-weight:bold\">I further declare that all the facts in this application are correct and complete to the best of my knowledge and belief.</span></p></td></tr><tr><td colspan=\"4\" style=\"width:178.9pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top\"><p class=\"note0\" style=\"margin-top:3pt; margin-bottom:0pt\"><span style=\"font-family:Arial, sans-serif\">The employee must sign this declaration*</span></p></td><td colspan=\"3\" style=\"width:158.9pt; border:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top\"><p style=\"font-size:10pt\"><span style=\"font-family:Arial, sans-serif\">Signature of employee</span></p><p style=\"font-size:10pt\"><span style=\"font-family:Arial, sans-serif\">………………………………………</span></p><p style=\"font-size:10pt\"><span style=\"font-family:Arial, sans-serif\">date</span><span style=\"width:74.34pt; font-family:Arial, sans-serif; display:inline-block\"> </span><span style=\"font-family:Arial, sans-serif\">/</span><span style=\"width:39.77pt; font-family:Arial, sans-serif; display:inline-block\"> </span><span style=\"font-family:Arial, sans-serif\">/</span></p></td></tr><tr><td colspan=\"4\" style=\"width:178.9pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top\"><p style=\"margin-top:3pt; font-size:10pt\"><span style=\"font-family:Arial, sans-serif; font-style:italic\">If a solicitor or authorised representative has prepared the application, that person must sign here</span></p></td><td colspan=\"3\" style=\"width:158.9pt; border:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top\"><p style=\"font-size:10pt\"><span style=\"font-family:Arial, sans-serif\">Signature of solicitor or representative</span></p><p style=\"font-size:10pt\"><span style=\"font-family:Arial, sans-serif\">………………………………………</span></p><p style=\"font-size:10pt\"><span style=\"font-family:Arial, sans-serif\">date</span><span style=\"width:74.34pt; font-family:Arial, sans-serif; display:inline-block\"> </span><span style=\"font-family:Arial, sans-serif\">/</span><span style=\"width:39.77pt; font-family:Arial, sans-serif; display:inline-block\"> </span><span style=\"font-family:Arial, sans-serif\">/</span></p></td></tr><tr><td colspan=\"4\" style=\"width:178.9pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top\"><p style=\"font-size:10pt\"><span style=\"font-family:Arial, sans-serif; font-style:italic\">If a union or an inspector is applying on behalf of the employee, a union representative or the inspector, as the case may be, must sign here</span></p></td><td colspan=\"3\" style=\"width:158.9pt; border:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top\"><p style=\"font-size:10pt\"><span style=\"font-family:Arial, sans-serif\">Signature for union or inspector</span></p><p style=\"font-size:10pt\"><span style=\"font-family:Arial, sans-serif\">………………………………………</span></p><p style=\"font-size:10pt\"><span style=\"font-family:Arial, sans-serif\">date</span><span style=\"width:74.34pt; font-family:Arial, sans-serif; font-style:italic; display:inline-block\"> </span><span style=\"font-family:Arial, sans-serif\">/</span><span style=\"width:39.77pt; font-family:Arial, sans-serif; display:inline-block\"> </span><span style=\"font-family:Arial, sans-serif\">/</span></p><p style=\"font-size:10pt\"><span style=\"font-family:Arial, sans-serif\">Name (print): ………………………………………</span></p><p style=\"font-size:10pt\"><span style=\"font-family:Arial, sans-serif\">position: ………………………………………</span></p></td></tr><tr style=\"height:0pt\"><td style=\"width:125.9pt\"></td><td style=\"width:14.2pt\"></td><td style=\"width:6.5pt\"></td><td style=\"width:43.1pt\"></td><td style=\"width:21.25pt\"></td><td style=\"width:77.95pt\"></td><td style=\"width:70.5pt\"></td></tr></tbody></table>\n```\n\nU No \\_\\_\\_\\_\\_\\_\\_\\_\\_\\_\\_\\_\\_\\_\\_\\_\\_\\_\\_\\_\\_\\_\\_\\_\\_\\_\\_\\_\\_\n\n| FEE [Section 170CEAA of the Workplace Relations Act 1996 requires a fee of $52.40 to be paid on lodgment of this application in the Commission unless a Registrar has approved the waiving of the fee (in which case a copy of the Registrar’s approval should accompany this application). If an application is lodged by facsimile transmission the credit card details must be provided] cash cheque/money order (to be made payable to Collector of Public Monies, Australian Industrial Registry) Bankcard  Visa  MastercardCard Number _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _Card Expiry Date ____ / ____Cardholder’s Name ________________________________________Normal Card Signature _____________________________________In the event of a refund of the lodging fee being applicable, the refund should be forwarded to:…………………………………………………………………………………………………………………………………………………………………………………… |\n| ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ |\n\nCommission Use Only\n\n## Receipt Number \\_\\_\\_\\_\\_\\_\\_\\_\\_\\_\\_\\_\\_\\_\\_\\_\\_\\_\\_\\_\\_\\_\\_\\_\\_\\_/Credit Transaction\n\n## Processed\\_\\_\\_\\_\\_\\_\\_\\_\\_\\_\\_\\_\\_\\_\\_\\_\\_\\_\\_\n\nForm R20 Application for relief in respect of termination of employment\n\n(rule 37)\n\n| Australian Industrial Relations CommissionApplication for relief in respect of termination of employment | Commission use onlyfile number |\n| -------------------------------------------------------------------------------------------------------- | ------------------------------ |\n| Workplace Relations Act 1996 (Cth)Subsection 170CE (3)                                                   | date received                  |\n\nThis Form is to be completed in respect of an application to the Commission for relief in respect of termination of employment solely on the ground or grounds of an alleged contravention of one or more of sections 170CK, 170CM and 170CN of the Workplace Relations Act 1996.\n\nIn making this claim the applicant union (being a trade union whose rules entitle it to represent the industrial interests of the employee) should be aware that:\n\n-   specified categories of employees are excluded from making a claim under the Termination of Employment provisions of the Workplace Relations Act 1996.\n-   section 170CJ of the Workplace Relations Act 1996 allows, in certain circumstances, the Commission to make an order for costs\n-   Section 170CEAA of the Workplace Relations Act 1996 requires a fee of $52.40 to be paid on lodgment of this application in the Commission unless a Registrar has approved the waiving of the fee. The $52.40 lodgment fee is refundable under certain circumstances\n\nDetails in relation to these matters are available from the Industrial Registry.\n\n  \nApplication is made by—\n\n| Name of union making application                     |                                                                                                    |\n| ---------------------------------------------------- | -------------------------------------------------------------------------------------------------- |\n| address of union                                     | …………………………………………………………………………………………………………………………………………. Postcode: ……Phone (….) …………………. Fax (…..) …… |\n| union contact person for notices from the Commission |                                                                                                    |\n\nThe application is made on behalf of the following employee/s\n\n```html\n<table cellspacing=\"0\" cellpadding=\"0\" style=\"width:360.15pt; border-collapse:collapse\"><tbody><tr><td colspan=\"2\" style=\"width:348.6pt; border:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top\"><p style=\"margin-top:3pt; margin-right:0.3pt; margin-bottom:9pt; font-size:10pt\"><span style=\"font-family:Arial, sans-serif\">Name/s of employee/s (or attached)</span></p><p style=\"margin-top:9pt; margin-right:0.3pt; margin-bottom:9pt; font-size:10pt\"><span style=\"font-family:Arial, sans-serif\"></span></p><p style=\"margin-top:9pt; margin-right:0.3pt; margin-bottom:6pt; font-size:10pt\"><span style=\"font-family:Arial, sans-serif\"></span></p></td></tr><tr><td colspan=\"2\" style=\"width:348.6pt; border:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top; background-color:#d8d8d8\"><p style=\"margin-top:3pt; margin-right:0.3pt; page-break-after:avoid; font-size:10pt\"><span style=\"font-family:Arial, sans-serif; font-weight:bold\">Grounds for application</span></p></td></tr><tr><td colspan=\"2\" style=\"width:348.6pt; border:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top\"><p style=\"margin-top:3pt; margin-right:0.3pt; margin-bottom:3pt; font-size:10pt\"><span style=\"font-family:Arial, sans-serif\">Identify the ground or grounds under subsection</span><span style=\"font-family:Arial, sans-serif\"> </span><span style=\"font-family:Arial, sans-serif\">170CE</span><span style=\"font-family:Arial, sans-serif\"> </span><span style=\"font-family:Arial, sans-serif\">(3) of the </span><span style=\"font-family:Arial, sans-serif; font-style:italic\">Workplace Relations Act 1996</span><span style=\"font-family:Arial, sans-serif\"> upon which this application is based—</span></p><p style=\"margin-top:3pt; margin-right:0.15pt; margin-bottom:3pt; font-size:10pt\"><span style=\"font-family:Arial, sans-serif\">on the ground or grounds of an alleged contravention of one or more of—</span></p><p style=\"margin-top:3pt; margin-right:0.15pt; margin-bottom:3pt; font-size:10pt\"><span style=\"font-family:Arial, sans-serif\">section</span><span style=\"font-family:Arial, sans-serif\"> </span><span style=\"font-family:Arial, sans-serif\">170CK </span><span style=\"font-family:Wingdings, serif\"></span><span style=\"font-family:Arial, sans-serif\">; and/ or</span></p><p style=\"margin-top:3pt; margin-right:0.15pt; margin-bottom:3pt; font-size:10pt\"><span style=\"font-family:Arial, sans-serif\">section</span><span style=\"font-family:Arial, sans-serif\"> </span><span style=\"font-family:Arial, sans-serif\">170CM </span><span style=\"font-family:Wingdings, serif\"></span><span style=\"font-family:Arial, sans-serif\">; and/ or</span></p><p style=\"margin-top:3pt; margin-right:0.3pt; font-size:10pt\"><span style=\"font-family:Arial, sans-serif\">section</span><span style=\"font-family:Arial, sans-serif\"> </span><span style=\"font-family:Arial, sans-serif\">170CN </span><span style=\"font-family:Wingdings, serif\"></span></p></td></tr><tr><td colspan=\"2\" style=\"width:348.6pt; border:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top; background-color:#e5e5e5\"><p style=\"margin-top:3pt; margin-right:0.3pt; page-break-after:avoid; font-size:10pt\"><span style=\"font-family:Arial, sans-serif; font-weight:bold\">Details of employer</span></p></td></tr><tr><td style=\"width:93.85pt; border:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top\"><p style=\"margin-top:12pt; margin-right:0.3pt; margin-bottom:3pt; page-break-after:avoid; font-size:10pt\"><span style=\"font-family:Arial, sans-serif\">employer’s name</span></p><p style=\"margin-top:3pt; margin-right:0.3pt; page-break-after:avoid; font-size:10pt\"><span style=\"font-family:Arial, sans-serif\">contact person</span></p></td><td style=\"width:243.95pt; border:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top\"><p style=\"margin:12pt 0.3pt 3pt 151.1pt; text-indent:-151.1pt; page-break-after:avoid; font-size:10pt\"><span style=\"font-family:Arial, sans-serif\">………………………………………………………………</span></p><p style=\"margin-top:3pt; margin-right:0.15pt; margin-left:151.1pt; text-indent:-151.1pt; page-break-after:avoid; font-size:10pt\"><span style=\"font-family:Arial, sans-serif\">……………………………………………………… ……</span></p></td></tr><tr><td style=\"width:93.85pt; border:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top\"><p style=\"margin-top:3pt; margin-right:0.3pt; font-size:10pt\"><span style=\"font-family:Arial, sans-serif\">employer’s trading address or registered office</span></p></td><td style=\"width:243.95pt; border:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top\"><p style=\"margin:12pt 0.3pt 3pt 151.1pt; text-indent:-148.85pt; font-size:10pt\"><span style=\"font-family:Arial, sans-serif\">………………………………………………………………</span></p><p style=\"margin:3pt 0.15pt 3pt 151.1pt; text-indent:-148.9pt; font-size:10pt\"><span style=\"font-family:Arial, sans-serif\">………………………………………………………………</span></p><p style=\"margin:3pt 0.15pt 3pt 151.1pt; text-indent:-148.9pt; font-size:10pt\"><span style=\"font-family:Arial, sans-serif\">………………………………….. Postcode ……………</span></p><p style=\"margin-top:3pt; margin-right:0.15pt; margin-left:151.1pt; text-indent:-148.9pt; font-size:10pt\"><span style=\"font-family:Arial, sans-serif\">Phone (…) …………………….. Fax (….) ……………</span></p></td></tr><tr><td style=\"width:93.85pt; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top\"><p style=\"margin-top:3pt; margin-right:0.15pt; font-size:10pt\"><span style=\"font-family:Arial, sans-serif\">date/s of termination of employee/s employment</span></p></td><td style=\"width:243.95pt; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top\"><p style=\"margin:18pt 0.3pt 3pt 151.1pt; text-indent:-148.85pt; font-size:10pt\"><span style=\"width:49.05pt; text-indent:0pt; font-family:Arial, sans-serif; font-weight:bold; display:inline-block\"></span><span style=\"font-family:Arial, sans-serif; font-weight:bold\">/</span><span style=\"width:39.72pt; text-indent:0pt; font-family:Arial, sans-serif; font-weight:bold; display:inline-block\"> </span><span style=\"font-family:Arial, sans-serif; font-weight:bold\">/</span></p><p style=\"margin-top:3pt; margin-right:0.15pt; margin-left:151.1pt; text-indent:-148.9pt; font-size:10pt\"><span style=\"font-family:Arial, sans-serif\"></span></p></td></tr></tbody></table>\n```\n\n  \n\n```html\n<table cellspacing=\"0\" cellpadding=\"0\" style=\"width:360.15pt; border-collapse:collapse\"><tbody><tr><td style=\"width:93.85pt; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top\"><p style=\"margin-top:3pt; margin-right:0.3pt; font-size:10pt\"><span style=\"font-family:Arial, sans-serif\">other employment details</span></p></td><td colspan=\"4\" style=\"width:243.95pt; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top\"><p class=\"BlockText\" style=\"margin-left:0pt; margin-bottom:18pt; font-size:10pt\"><span style=\"font-family:Arial, sans-serif\">State the name of the award or agreement (including Australian Workplace Agreement) under which the employee/s were employed immediately prior to the termination/s</span></p><p style=\"margin-top:18pt; margin-right:0.3pt; margin-left:1.7pt; font-size:10pt\"><span style=\"font-family:Arial, sans-serif\">………………………………………………………………</span></p></td></tr><tr><td style=\"width:93.85pt; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top\"><p style=\"margin-top:3pt; margin-right:0.3pt; font-size:10pt\"><span style=\"font-family:Arial, sans-serif\"></span></p></td><td colspan=\"4\" style=\"width:243.95pt; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top\"><p style=\"margin:3pt 0.3pt 3pt 1.7pt; font-size:10pt\"><span style=\"font-family:Arial, sans-serif\">State whether the award or agreement is State or Federal</span></p><p style=\"margin-top:3pt; margin-right:0.3pt; margin-left:1.7pt; font-size:10pt\"><span style=\"font-family:Wingdings, serif\"></span><span style=\"font-family:Arial, sans-serif\"> Federal </span><span style=\"font-family:Wingdings, serif\"></span><span style=\"font-family:Arial, sans-serif\"> State If State, name of State: …………………………</span></p></td></tr><tr><td colspan=\"5\" style=\"width:348.6pt; border:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top; background-color:#e5e5e5\"><p style=\"margin-top:3pt; margin-right:0.3pt; page-break-after:avoid; font-size:10pt\"><span style=\"font-family:Arial, sans-serif; font-weight:bold\">Relief Sought</span></p></td></tr><tr><td style=\"width:93.85pt; border:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top\"><p style=\"margin-top:3pt; margin-right:0.15pt; page-break-after:avoid; font-size:10pt\"><span style=\"font-family:Arial, sans-serif\">Identify the type of relief being sought</span></p></td><td colspan=\"2\" style=\"width:75.95pt; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.03pt; vertical-align:top\"><p style=\"margin-top:3pt; margin-right:0.3pt; page-break-after:avoid; font-size:10pt\"><span style=\"font-family:'Monotype Sorts', serif\"></span><span style=\"font-family:Arial, sans-serif\"> reinstatement</span></p></td><td style=\"width:73.2pt; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top\"><p style=\"margin-top:3pt; margin-right:0.3pt; page-break-after:avoid; font-size:10pt\"><span style=\"font-family:Wingdings, serif\"></span><span style=\"font-family:Arial, sans-serif\"> compensation</span></p></td><td style=\"width:73.2pt; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.4pt; vertical-align:top\"><p style=\"margin-right:0.3pt; margin-bottom:30pt; page-break-after:avoid; font-size:10pt\"><span style=\"font-family:Wingdings, serif\"></span><span style=\"font-family:Arial, sans-serif\"> other—give details</span></p></td></tr><tr><td colspan=\"5\" style=\"width:348.6pt; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:5.03pt; padding-left:5.03pt; vertical-align:top; background-color:#e5e5e5\"><p style=\"margin-right:0.3pt; font-size:10pt\"><span style=\"font-family:Arial, sans-serif; font-weight:bold\">Declaration</span></p></td></tr><tr><td colspan=\"5\" style=\"width:348.6pt; border-top:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top\"><p style=\"margin-right:0.3pt; font-size:10pt\"><span style=\"font-family:Arial, sans-serif\">I declare that all the facts in this application are correct and complete to the best of my knowledge and belief.</span></p></td></tr><tr><td colspan=\"2\" style=\"width:165pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top\"><p style=\"margin-right:0.3pt; font-size:10pt\"><span style=\"font-family:Arial, sans-serif; font-style:italic\">Union representative must sign here</span></p></td><td colspan=\"3\" style=\"width:172.8pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top\"><p style=\"margin-top:5pt; margin-right:0.3pt; margin-bottom:5pt; font-size:10pt\"><span style=\"font-family:Arial, sans-serif; font-style:italic\">……………………………………………</span></p><p style=\"margin-top:5pt; margin-right:0.15pt; margin-bottom:5pt; font-size:10pt\"><span style=\"font-family:Arial, sans-serif\">Date</span><span style=\"width:72.43pt; font-family:Arial, sans-serif; display:inline-block\"> </span><span style=\"font-family:Arial, sans-serif\">/</span><span style=\"width:39.72pt; font-family:Arial, sans-serif; display:inline-block\"> </span><span style=\"font-family:Arial, sans-serif\">/</span></p><p style=\"margin-top:5pt; margin-right:0.3pt; margin-bottom:5pt; font-size:10pt\"><span style=\"font-family:Arial, sans-serif\">Name (print) ……………………………………………</span></p><p style=\"margin-top:5pt; margin-right:0.3pt; font-size:10pt\"><span style=\"font-family:Arial, sans-serif\">Position ……………………………………………</span></p></td></tr><tr style=\"height:0pt\"><td style=\"width:104.65pt\"></td><td style=\"width:71.15pt\"></td><td style=\"width:15.6pt\"></td><td style=\"width:84pt\"></td><td style=\"width:84pt\"></td></tr></tbody></table>\n```\n\nU No \\_\\_\\_\\_\\_\\_\\_\\_\\_\\_\\_\\_\\_\\_\\_\\_\\_\\_\\_\\_\\_\\_\\_\\_\\_\\_\\_\\_\\_\n\n| FEE [Section 170CEAA of the Workplace Relations Act 1996 requires a fee of $52.40 to be paid on lodgment of this application in the Commission unless a Registrar has approved the waiving of the fee (in which case a copy of the Registrar’s approval should accompany this application). If an application is lodged by facsimile transmission the credit card details must be provided] cash cheque/money order (to be made payable to Collector of Public Monies, Australian Industrial Registry) Bankcard  Visa  MastercardCard Number _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _Card Expiry Date ____ / ____Cardholder’s Name_________________________________________Normal Card Signature ______________________________________In the event of a refund of the lodging fee being applicable, the refund should be forwarded to:……………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………… |\n| -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- |\n\nCommission Use Only\n\n## Receipt Number \\_\\_\\_\\_\\_\\_\\_\\_\\_\\_\\_\\_\\_\\_\\_\\_\\_\\_\\_\\_\\_\\_\\_\\_\\_\\_/Credit Transaction\n\n## Processed\\_\\_\\_\\_\\_\\_\\_\\_\\_\\_\\_\\_\\_\\_\\_\\_\\_\\_\\_\n\nForm R21 Notice of employer’s appearance — termination of employment\n\n(rule 38)\n\n```html\n<table cellspacing=\"0\" cellpadding=\"0\" style=\"width:347.65pt; margin-left:6.98pt; border-collapse:collapse\"><tbody><tr><td rowspan=\"2\" style=\"width:186.2pt; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:5.35pt; padding-left:4.97pt; vertical-align:top\"><p class=\"Schedulepara\" style=\"margin-top:1pt; margin-left:0pt; margin-bottom:4pt; text-indent:0pt; text-align:left\"><span style=\"font-family:Arial, sans-serif; font-size:10pt\">Australian Industrial Relations Commission</span></p><p class=\"FormHeading\" style=\"margin-top:4pt; margin-bottom:4pt; text-align:left\"><span style=\"text-transform:none\">Notice of Employer’s appearance — termination of employment</span></p><p style=\"margin-top:4pt; margin-bottom:4pt; font-size:10pt\"><span style=\"font-family:Arial, sans-serif; font-style:italic\">Workplace Relations Act 1996 </span><span style=\"font-family:Arial, sans-serif\">(Commonwealth)</span></p><p class=\"Schedulepara\" style=\"margin-top:4pt; margin-left:0pt; margin-bottom:3pt; text-indent:0pt; text-align:left\"><span style=\"font-family:Arial, sans-serif; font-size:10pt\">Section 170CE</span></p></td><td style=\"width:139.3pt; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top\"><p style=\"margin-bottom:1pt; font-size:10pt\"><span style=\"font-family:Arial, sans-serif\">Commission use only</span></p><p style=\"margin-top:1pt; margin-right:0.3pt; margin-bottom:4pt; font-size:10pt\"><span style=\"font-family:Arial, sans-serif\">File number:</span></p><p style=\"margin-top:4pt; margin-right:0.3pt; margin-bottom:3pt; font-size:10pt\"><span style=\"font-family:Arial, sans-serif; font-weight:bold\"></span></p></td></tr><tr><td style=\"width:139.3pt; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top\"><p style=\"margin-top:1pt; margin-right:0.15pt; margin-bottom:3pt; font-size:10pt\"><span style=\"font-family:Arial, sans-serif\">Date received:</span></p></td></tr><tr><td colspan=\"2\" style=\"width:336.2pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top\"><p class=\"Schedulepara\" style=\"margin-left:1.75pt; text-indent:0pt; text-align:left\"><span style=\"font-family:Arial, sans-serif; font-size:10pt; font-style:italic\">Please place a tick or cross, where necessary, in the boxes below.</span></p></td></tr><tr><td colspan=\"2\" style=\"width:336.2pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top; background-color:#f2f2f2\"><p class=\"Schedulepara\" style=\"margin-left:1.7pt; margin-bottom:3pt; text-indent:0pt; text-align:left; page-break-after:avoid\"><span style=\"font-family:Arial, sans-serif; font-size:10pt; font-weight:bold; font-style:italic\">Application details (as stated in Form R18)</span></p></td></tr><tr><td style=\"width:186.2pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top\"><p class=\"Schedulepara\" style=\"margin-top:1pt; margin-left:14.55pt; margin-bottom:3pt; text-indent:-14.55pt; text-align:left\"><span style=\"font-family:Arial, sans-serif\"></span><span style=\"font-family:Arial, sans-serif; font-size:10pt\">1 Former employee’s full name as appearing on Form R18</span></p></td><td style=\"width:139.3pt; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:4.97pt; padding-left:5.35pt; vertical-align:top\"><p style=\"margin-top:1pt; margin-left:1.75pt; margin-bottom:3pt\"><span style=\"font-family:Arial, sans-serif\"></span></p></td></tr><tr><td style=\"width:186.2pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top\"><p class=\"Schedulepara\" style=\"margin-top:1pt; margin-left:14.55pt; margin-bottom:3pt; text-indent:-12.8pt; text-align:left\"><span style=\"font-family:Arial, sans-serif\"></span><span style=\"font-family:Arial, sans-serif; font-size:10pt\">2 Commission Case/</span><br><span style=\"font-family:Arial, sans-serif; font-size:10pt\">File Number</span></p></td><td style=\"width:139.3pt; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:4.97pt; padding-left:5.35pt; vertical-align:top\"><p class=\"Schedulepara\" style=\"margin-top:1pt; margin-left:14.55pt; margin-bottom:3pt; text-indent:-12.8pt; text-align:left\"><span style=\"font-family:Arial, sans-serif; font-size:10pt\">U</span></p></td></tr><tr><td colspan=\"2\" style=\"width:336.2pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top; background-color:#f2f2f2\"><p class=\"Schedulepara\" style=\"margin-top:1pt; margin-left:17.85pt; margin-bottom:3pt; text-indent:-16.1pt; text-align:left\"><span style=\"font-family:Arial, sans-serif; font-size:10pt\">Details of employer</span></p></td></tr><tr><td style=\"width:186.2pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top\"><p class=\"Schedulepara\" style=\"margin-top:1pt; margin-left:17.85pt; margin-bottom:3pt; text-indent:-16.1pt; text-align:left\"><span style=\"font-family:Arial, sans-serif; font-size:10pt\">3</span><span style=\"width:10.54pt; text-indent:0pt; font-family:Arial, sans-serif; font-size:10pt; display:inline-block\"> </span><span style=\"font-family:Arial, sans-serif; font-size:10pt\">Employer named on application</span></p></td><td style=\"width:139.3pt; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:4.97pt; padding-left:5.35pt; vertical-align:top\"><p style=\"margin-top:1pt; margin-left:1.7pt; margin-bottom:4pt\"><span style=\"font-family:Arial, sans-serif\"></span></p><p style=\"margin-top:4pt; margin-left:1.7pt; margin-bottom:3pt\"><span style=\"font-family:Arial, sans-serif\"></span></p></td></tr><tr><td style=\"width:186.2pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top\"><p class=\"Schedulepara\" style=\"margin-top:1pt; margin-left:17.85pt; margin-bottom:3pt; text-indent:-16.1pt; text-align:left\"><span style=\"font-family:Arial, sans-serif; font-size:10pt\">4</span><span style=\"width:10.54pt; text-indent:0pt; font-family:Arial, sans-serif; font-size:10pt; display:inline-block\"> </span><span style=\"font-family:Arial, sans-serif; font-size:10pt\">Has the applicant given the employer's correct name?</span></p></td><td style=\"width:139.3pt; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:4.97pt; padding-left:5.35pt; vertical-align:top\"><p class=\"Schedulepara\" style=\"margin-top:1pt; margin-left:1.75pt; margin-bottom:4pt; text-indent:0pt; text-align:left\"><span style=\"font-family:Arial, sans-serif; font-size:10pt\">Yes </span><span style=\"font-family:Wingdings, serif; font-size:10pt\"></span><span style=\"font-family:Arial, sans-serif; font-size:10pt\"> No </span><span style=\"font-family:Wingdings, serif; font-size:10pt\"></span><br><span style=\"font-family:Arial, sans-serif; font-size:10pt\">If no, correct name is</span></p><p style=\"margin-top:4pt; margin-left:1.75pt; margin-bottom:3pt; font-size:10pt\"><span style=\"font-family:Arial, sans-serif\"></span></p></td></tr><tr><td style=\"width:186.2pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top\"><p class=\"Schedulepara\" style=\"margin-top:1pt; margin-left:17.85pt; margin-bottom:3pt; text-indent:-16.1pt; text-align:left\"><span style=\"font-family:Arial, sans-serif; font-size:10pt\">5</span><span style=\"width:10.54pt; text-indent:0pt; font-family:Arial, sans-serif; font-size:10pt; display:inline-block\"> </span><span style=\"font-family:Arial, sans-serif; font-size:10pt\">Employer’s address</span></p></td><td style=\"width:139.3pt; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:4.97pt; padding-left:5.35pt; vertical-align:top\"><p style=\"margin-top:1pt; margin-left:1.75pt; margin-bottom:4pt\"><span style=\"font-family:Arial, sans-serif\"></span></p><p class=\"Schedulepara\" style=\"margin-top:4pt; margin-left:0.65pt; margin-bottom:3pt; text-indent:0pt; text-align:left\"><span style=\"font-family:Arial, sans-serif; font-size:10pt\">Postcode:</span></p></td></tr><tr><td style=\"width:186.2pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top\"><p class=\"Schedulepara\" style=\"margin-top:1pt; margin-left:17.85pt; margin-bottom:3pt; text-indent:-16.1pt; text-align:left\"><span style=\"font-family:Arial, sans-serif; font-size:10pt\">6</span><span style=\"width:10.54pt; text-indent:0pt; font-family:Arial, sans-serif; font-size:10pt; display:inline-block\"> </span><span style=\"font-family:Arial, sans-serif; font-size:10pt\">Details of contact person</span></p></td><td style=\"width:139.3pt; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:4.97pt; padding-left:5.35pt; vertical-align:top\"><p style=\"margin-top:1pt; margin-left:1.75pt; margin-bottom:4pt\"><span style=\"font-family:Arial, sans-serif\"></span></p><p class=\"Schedulepara\" style=\"margin-top:4pt; margin-left:1.75pt; margin-bottom:4pt; text-indent:0pt; text-align:left\"><span style=\"font-family:Arial, sans-serif; font-size:10pt; font-style:italic\">[first name] [family name]</span></p><p class=\"Schedulepara\" style=\"margin-top:4pt; margin-left:1.75pt; margin-bottom:4pt; text-indent:0pt; text-align:left\"><span style=\"font-family:Arial, sans-serif; font-size:10pt\">Phone ( )</span></p><p class=\"Schedulepara\" style=\"margin-top:4pt; margin-left:1.75pt; margin-bottom:4pt; text-indent:0pt; text-align:left\"><span style=\"font-family:Arial, sans-serif; font-size:10pt\">Fax ( )</span></p><p class=\"Schedulepara\" style=\"margin-top:4pt; margin-left:1.75pt; margin-bottom:3pt; text-indent:0pt; text-align:left\"><span style=\"font-family:Arial, sans-serif; font-size:10pt\">Mobile</span></p></td></tr><tr><td style=\"width:186.2pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top\"><p class=\"Schedulepara\" style=\"margin-top:1pt; margin-left:17.85pt; margin-bottom:3pt; text-indent:-16.1pt; text-align:left\"><span style=\"font-family:Arial, sans-serif; font-size:10pt\">7</span><span style=\"width:10.54pt; text-indent:0pt; font-family:Arial, sans-serif; font-size:10pt; display:inline-block\"> </span><span style=\"font-family:Arial, sans-serif; font-size:10pt\">Employer’s details</span></p></td><td style=\"width:139.3pt; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:4.97pt; padding-left:5.35pt; vertical-align:top\"><p class=\"Schedulepara\" style=\"margin-top:1pt; margin-left:1.75pt; margin-bottom:4pt; text-indent:0pt; text-align:left\"><span style=\"font-family:Wingdings, serif; font-size:10pt\"></span><span style=\"font-family:Arial, sans-serif; font-size:10pt\"> Company</span></p><p class=\"Schedulepara\" style=\"margin-top:4pt; margin-left:1.75pt; margin-bottom:4pt; text-indent:0pt; text-align:left\"><span style=\"font-family:Arial, sans-serif; font-size:10pt\">ACN _______________</span></p><p style=\"margin-top:4pt; margin-left:1.7pt; margin-bottom:4pt; font-size:10pt\"><span style=\"font-family:Wingdings, serif\"></span><span style=\"font-family:Arial, sans-serif\"> Partnership</span></p><p style=\"margin-top:4pt; margin-left:1.7pt; margin-bottom:4pt; font-size:10pt\"><span style=\"font-family:Wingdings, serif\"></span><span style=\"font-family:Arial, sans-serif\"> Sole trader</span></p><p style=\"margin-top:4pt; margin-left:1.7pt; margin-bottom:4pt; font-size:10pt\"><span style=\"font-family:Wingdings, serif\"></span><span style=\"font-family:Arial, sans-serif\"> Government Authority</span></p><p style=\"margin-top:4pt; margin-left:1.7pt; margin-bottom:3pt; font-size:10pt\"><span style=\"font-family:Wingdings, serif\"></span><span style=\"font-family:Arial, sans-serif\"> Other (specify)</span></p></td></tr><tr><td style=\"width:186.2pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top\"><p class=\"Schedulepara\" style=\"margin-top:1pt; margin-left:17.85pt; margin-bottom:3pt; text-indent:-16.1pt; text-align:left\"><span style=\"font-family:Arial, sans-serif; font-size:10pt\">8</span><span style=\"width:10.54pt; text-indent:0pt; font-family:Arial, sans-serif; font-size:10pt; display:inline-block\"> </span><span style=\"font-family:Arial, sans-serif; font-size:10pt\">Was the employer named in item 3 or 4 above the employer of the applicant at the time of termination?</span></p></td><td style=\"width:139.3pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top\"><p style=\"margin-top:1pt; margin-left:1.7pt; margin-bottom:4pt; font-size:10pt\"><span style=\"font-family:Wingdings, serif\"></span><span style=\"font-family:Arial, sans-serif\"> Yes </span><span style=\"font-family:Wingdings, serif\"></span><span style=\"font-family:Arial, sans-serif\"> No</span></p><p style=\"margin-top:4pt; margin-left:1.7pt; margin-bottom:4pt; font-size:10pt\"><span style=\"font-family:Arial, sans-serif\">If no, what was the name and address of employer at time of termination?</span></p><p style=\"margin-top:4pt; margin-left:1.7pt; margin-bottom:3pt; font-size:10pt\"><span style=\"font-family:Arial, sans-serif\"></span></p></td></tr><tr><td style=\"width:186.2pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top\"><p class=\"Schedulepara\" style=\"margin-top:1pt; margin-left:17.85pt; margin-bottom:3pt; text-indent:-16.1pt; text-align:left\"><span style=\"font-family:Arial, sans-serif; font-size:10pt\">9</span><span style=\"width:10.54pt; text-indent:0pt; font-family:Arial, sans-serif; font-size:10pt; display:inline-block\"> </span><span style=\"font-family:Arial, sans-serif; font-size:10pt\">Was the applicant employed under an award or agreement (including an Australian Workplace Agreement) immediately before the termination?</span></p></td><td style=\"width:139.3pt; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:4.97pt; padding-left:5.35pt; vertical-align:top\"><p style=\"margin-top:1pt; margin-left:1.7pt; margin-bottom:4pt; font-size:10pt\"><span style=\"font-family:Wingdings, serif\"></span><span style=\"font-family:Arial, sans-serif\"> Yes </span><span style=\"font-family:Wingdings, serif\"></span><span style=\"font-family:Arial, sans-serif\"> No</span></p><p style=\"margin-top:4pt; margin-left:1.7pt; margin-bottom:4pt; font-size:10pt\"><span style=\"font-family:Arial, sans-serif\">If yes, was it:</span><span style=\"width:24.26pt; font-family:Arial, sans-serif; display:inline-block\"></span></p><p style=\"margin-top:4pt; margin-left:1.7pt; margin-bottom:4pt; font-size:10pt\"><span style=\"font-family:Arial, sans-serif\">Federal </span><span style=\"font-family:Wingdings, serif\"></span><span style=\"font-family:Arial, sans-serif\"> or</span><span style=\"width:24.78pt; font-family:Arial, sans-serif; display:inline-block\"> </span><span style=\"font-family:Arial, sans-serif\">State </span><span style=\"font-family:Wingdings, serif\"></span></p><p style=\"margin-top:4pt; margin-left:1.7pt; margin-bottom:4pt; font-size:10pt\"><span style=\"font-family:Arial, sans-serif\"></span></p><p style=\"margin-top:4pt; margin-left:1.7pt; margin-bottom:3pt; font-size:10pt\"><span style=\"font-family:Arial, sans-serif\">If State, which State?</span></p></td></tr><tr><td colspan=\"2\" style=\"width:336.2pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top; background-color:#f2f2f2\"><p class=\"Schedulepara\" style=\"margin-top:8pt; margin-left:1.7pt; text-indent:0pt; text-align:left; page-break-after:avoid\"><span style=\"font-family:Arial, sans-serif; font-size:10pt; font-weight:bold\">Details of employer’s representative</span></p></td></tr><tr><td style=\"width:186.2pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top\"><p class=\"Schedulepara\" style=\"margin-top:1pt; margin-left:17.85pt; margin-bottom:3pt; text-indent:-16.1pt; text-align:left; page-break-after:avoid\"><span style=\"font-family:Arial, sans-serif; font-size:10pt\">10</span><span style=\"width:4.98pt; text-indent:0pt; font-family:Arial, sans-serif; font-size:10pt; display:inline-block\"> </span><span style=\"font-family:Arial, sans-serif; font-size:10pt\">Is anyone representing the employer?</span></p></td><td style=\"width:139.3pt; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:4.97pt; padding-left:5.35pt; vertical-align:top\"><p class=\"Schedulepara\" style=\"margin-top:1pt; margin-left:17.85pt; margin-bottom:4pt; text-indent:-16.1pt; text-align:left; page-break-after:avoid\"><span style=\"font-family:Arial, sans-serif; font-size:10pt\">Yes </span><span style=\"font-family:Wingdings, serif; font-size:10pt\"></span><span style=\"font-family:Arial, sans-serif; font-size:10pt\"> go to item 11</span></p><p class=\"Schedulepara\" style=\"margin-top:4pt; margin-left:17.85pt; margin-bottom:3pt; text-indent:-16.1pt; text-align:left; page-break-after:avoid\"><span style=\"font-family:Arial, sans-serif; font-size:10pt\">No </span><span style=\"font-family:Wingdings, serif; font-size:10pt\"></span><span style=\"font-family:Arial, sans-serif; font-size:10pt\"> go to item 14</span></p></td></tr><tr><td style=\"width:186.2pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top\"><p class=\"Schedulepara\" style=\"margin-top:1pt; margin-left:17.85pt; margin-bottom:3pt; text-indent:-16.1pt; text-align:left; page-break-after:avoid\"><span style=\"font-family:Arial, sans-serif; font-size:10pt\">11</span><span style=\"width:4.98pt; text-indent:0pt; font-family:Arial, sans-serif; font-size:10pt; display:inline-block\"> </span><span style=\"font-family:Arial, sans-serif; font-size:10pt\">Name of solicitor, legal firm, employer organisation or other representative</span></p></td><td style=\"width:139.3pt; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:4.97pt; padding-left:5.35pt; vertical-align:top\"><p style=\"margin-top:1pt; margin-left:1.75pt; margin-bottom:3pt\"><span style=\"font-family:Arial, sans-serif\"></span></p></td></tr><tr><td style=\"width:186.2pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top\"><p class=\"Schedulepara\" style=\"margin-top:1pt; margin-left:17.85pt; margin-bottom:3pt; text-indent:-16.1pt; text-align:left; page-break-after:avoid\"><span style=\"font-family:Arial, sans-serif; font-size:10pt\">12</span><span style=\"width:4.98pt; text-indent:0pt; font-family:Arial, sans-serif; font-size:10pt; display:inline-block\"> </span><span style=\"font-family:Arial, sans-serif; font-size:10pt\">Contact details of solicitor, legal firm, employer organisation or other representative</span></p></td><td style=\"width:139.3pt; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:4.97pt; padding-left:5.35pt; vertical-align:top\"><p style=\"margin-top:1pt; margin-bottom:4pt\"><span style=\"font-family:Arial, sans-serif\"></span></p><p style=\"margin-top:4pt; margin-bottom:4pt; font-size:10pt\"><span style=\"font-family:Arial, sans-serif; font-style:italic\">[first name] [family name]</span></p><p class=\"Schedulepara\" style=\"margin-top:4pt; margin-left:1.75pt; margin-bottom:4pt; text-indent:0pt; text-align:left\"><span style=\"font-family:Arial, sans-serif; font-size:10pt\">Phone ( )</span></p><p class=\"Schedulepara\" style=\"margin-top:4pt; margin-left:1.75pt; margin-bottom:4pt; text-indent:0pt; text-align:left\"><span style=\"font-family:Arial, sans-serif; font-size:10pt\">Fax ( )</span></p><p class=\"Schedulepara\" style=\"margin-top:4pt; margin-left:1.75pt; margin-bottom:3pt; text-indent:0pt; text-align:left\"><span style=\"font-family:Arial, sans-serif; font-size:10pt\">Mobile</span></p></td></tr><tr><td style=\"width:186.2pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top\"><p class=\"Schedulepara\" style=\"margin-top:1pt; margin-left:17.85pt; margin-bottom:3pt; text-indent:-16.1pt; text-align:left; page-break-after:avoid\"><span style=\"font-family:Arial, sans-serif; font-size:10pt\">13</span><span style=\"width:4.98pt; text-indent:0pt; font-family:Arial, sans-serif; font-size:10pt; display:inline-block\"> </span><span style=\"font-family:Arial, sans-serif; font-size:10pt\">Address of solicitor, legal firm, employer organisation or other representative</span></p></td><td style=\"width:139.3pt; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:4.97pt; padding-left:5.35pt; vertical-align:top\"><p style=\"margin-top:1pt; margin-left:1.75pt; margin-bottom:4pt\"><span style=\"font-family:Arial, sans-serif\"></span></p><p class=\"Schedulepara\" style=\"margin-top:4pt; margin-left:1.75pt; margin-bottom:3pt; text-indent:0pt; text-align:left\"><span style=\"font-family:Arial, sans-serif; font-size:10pt\">Postcode:</span></p></td></tr><tr><td colspan=\"2\" style=\"width:336.2pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top; background-color:#f2f2f2\"><p class=\"Schedulepara\" style=\"margin-left:1.75pt; text-indent:0pt; text-align:left; page-break-after:avoid\"><span style=\"font-family:Arial, sans-serif; font-size:10pt; font-weight:bold\">Address for notices</span></p></td></tr><tr><td style=\"width:186.2pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top\"><p class=\"Schedulepara\" style=\"margin-top:1pt; margin-left:17.85pt; margin-bottom:3pt; text-indent:-16.1pt; text-align:left\"><span style=\"font-family:Arial, sans-serif; font-size:10pt\">14</span><span style=\"width:4.98pt; text-indent:0pt; font-family:Arial, sans-serif; font-size:10pt; display:inline-block\"> </span><span style=\"font-family:Arial, sans-serif; font-size:10pt\">Where does the employer want notices to be sent?</span></p></td><td style=\"width:139.3pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top\"><p style=\"margin-top:1pt; margin-left:1.75pt; margin-bottom:4pt\"><span style=\"font-family:Arial, sans-serif; font-size:10pt\">Business address </span><span style=\"font-family:Wingdings, serif\"></span></p><p style=\"margin-top:4pt; margin-left:1.75pt; margin-bottom:4pt\"><span style=\"font-family:Arial, sans-serif; font-size:10pt\">or address of solicitor, employer organisation or other representative</span><span style=\"width:19.88pt; font-family:Arial, sans-serif; display:inline-block\"> </span><span style=\"font-family:Wingdings, serif\"></span></p><p class=\"Schedulepara\" style=\"margin-top:4pt; margin-left:1.75pt; margin-bottom:3pt; text-indent:0pt; text-align:left\"><span style=\"font-family:Arial, sans-serif; font-size:10pt; font-style:italic\">Choose only one option</span></p></td></tr><tr><td colspan=\"2\" style=\"width:336.2pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top; background-color:#f2f2f2\"><p class=\"Schedulepara\" style=\"margin-left:1.7pt; text-indent:0pt; text-align:left; page-break-after:avoid\"><span style=\"font-family:Arial, sans-serif; font-size:10pt; font-weight:bold\">Reasons for termination</span></p></td></tr><tr><td style=\"width:186.2pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top\"><p class=\"Schedulepara\" style=\"margin-top:1pt; margin-left:17.85pt; margin-bottom:3pt; text-indent:-16.1pt; text-align:left\"><span style=\"font-family:Arial, sans-serif; font-size:10pt\">15</span><span style=\"width:4.98pt; text-indent:0pt; font-family:Arial, sans-serif; font-size:10pt; display:inline-block\"> </span><span style=\"font-family:Arial, sans-serif; font-size:10pt\">Brief summary of reason(s) given to employee for termination</span></p></td><td style=\"width:139.3pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top\"><p class=\"Schedulepara\" style=\"margin-top:1pt; margin-left:1.75pt; margin-bottom:4pt; text-indent:0pt; text-align:left\"><span style=\"font-family:Arial, sans-serif; font-size:10pt; font-style:italic\">Write here or attach document</span></p><p class=\"Schedulepara\" style=\"margin-top:4pt; margin-left:1.75pt; margin-bottom:4pt; text-indent:0pt; text-align:left\"><span style=\"font-family:Arial, sans-serif\"></span></p><p style=\"margin-top:4pt; margin-left:1.75pt; margin-bottom:4pt\"><span style=\"font-family:Arial, sans-serif\"></span></p><p style=\"margin-top:4pt; margin-left:1.75pt; margin-bottom:4pt\"><span style=\"font-family:Arial, sans-serif\"></span></p><p style=\"margin-top:4pt; margin-left:1.75pt; margin-bottom:3pt\"><span style=\"font-family:Arial, sans-serif\"></span></p></td></tr><tr><td colspan=\"2\" style=\"width:336.2pt; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top; background-color:#f2f2f2\"><p class=\"Schedulepara\" style=\"margin-left:1.7pt; text-indent:0pt; text-align:left; page-break-after:avoid\"><span style=\"font-family:Arial, sans-serif; font-size:10pt; font-weight:bold\">Late lodgment objection (if applicable)</span></p></td></tr><tr><td colspan=\"2\" style=\"width:336.2pt; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top\"><p class=\"Schedulepara\" style=\"margin-top:1pt; margin-left:17.85pt; margin-bottom:4pt; text-indent:-16.1pt\"><span style=\"font-family:Arial, sans-serif; font-size:10pt\">16</span><span style=\"width:4.98pt; text-indent:0pt; font-family:Arial, sans-serif; font-size:10pt; display:inline-block\"> </span><span style=\"font-family:Arial, sans-serif; font-size:10pt\">If the application was lodged in the Commission more than 21 days after the day on which the termination took effect, the Commission must decide whether to accept the application.</span></p><p class=\"Schedulepara\" style=\"margin-top:4pt; margin-left:17.85pt; margin-bottom:3pt; text-indent:-16.15pt; page-break-after:avoid; line-height:normal; font-size:10pt\"><span style=\"width:16.15pt; text-indent:0pt; font-family:Arial, sans-serif; display:inline-block\"></span><span style=\"font-family:Arial, sans-serif\">If the application was lodged out of time, please indicate whether the employer objects to the Commission extending the time for lodgment.</span></p></td></tr><tr><td colspan=\"2\" style=\"width:336.2pt; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top\"><p class=\"Schedulepara\" style=\"margin-top:1pt; margin-left:17.85pt; margin-bottom:3pt; text-indent:-16.15pt; page-break-after:avoid; line-height:normal; font-size:10pt\"><span style=\"font-family:Wingdings, serif\"></span><span style=\"width:7.24pt; text-indent:0pt; font-family:Arial, sans-serif; display:inline-block\"> </span><span style=\"width:0pt; text-indent:0pt; font-family:Arial, sans-serif; display:inline-block\"></span><span style=\"font-family:Arial, sans-serif\">I object to the Commission extending the time for lodgment and also object to conciliation before determination of the application to extend time; OR</span></p></td></tr><tr><td colspan=\"2\" style=\"width:336.2pt; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top\"><p class=\"Schedulepara\" style=\"margin-top:1pt; margin-left:17.85pt; margin-bottom:3pt; text-indent:-16.15pt; page-break-after:avoid; line-height:normal; font-size:10pt\"><span style=\"font-family:Wingdings, serif\"></span><span style=\"width:7.24pt; text-indent:0pt; font-family:Arial, sans-serif; display:inline-block\"> </span><span style=\"width:0pt; text-indent:0pt; font-family:Arial, sans-serif; display:inline-block\"></span><span style=\"font-family:Arial, sans-serif\">I object to the Commission extending the time for lodgment but do not object to conciliation before determination of the application to extend time; OR</span></p></td></tr><tr><td colspan=\"2\" style=\"width:336.2pt; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top\"><p class=\"Schedulepara\" style=\"margin-top:1pt; margin-left:17.85pt; margin-bottom:3pt; text-indent:-16.15pt; page-break-after:avoid; line-height:normal; font-size:10pt\"><span style=\"font-family:Wingdings, serif\"></span><span style=\"width:7.24pt; text-indent:0pt; font-family:Arial, sans-serif; display:inline-block\"> </span><span style=\"width:0pt; text-indent:0pt; font-family:Arial, sans-serif; display:inline-block\"></span><span style=\"font-family:Arial, sans-serif\">I do not object to the Commission extending the time for lodgment.</span></p></td></tr></tbody></table>\n```\n\n  \n\n```html\n<table cellspacing=\"0\" cellpadding=\"0\" style=\"width:347.65pt; margin-left:6.85pt; border:0.75pt solid #000000; border-collapse:collapse\"><tbody><tr><td colspan=\"2\" style=\"width:336.2pt; border-bottom:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top; background-color:#f2f2f2\"><p style=\"margin-left:17.85pt; margin-bottom:3pt; text-indent:-16.15pt; font-size:10pt\"><span style=\"font-family:Arial, sans-serif; font-weight:bold\">Dismissal for want of jurisdiction (if applicable)</span></p></td></tr><tr><td colspan=\"2\" style=\"width:336.2pt; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top\"><p style=\"margin-top:1pt; margin-bottom:3pt; font-size:10pt\"><span style=\"font-family:Arial, sans-serif; font-style:italic\">Note</span><span style=\"font-family:Arial, sans-serif\"> </span><span style=\"font-family:Arial, sans-serif\"></span><span style=\"font-family:Arial, sans-serif\"></span><span style=\"font-family:Arial, sans-serif\">If the employer intends to move for the dismissal of the application for want of jurisdiction, Form R21A must be completed and filed.</span></p></td></tr><tr><td colspan=\"2\" style=\"width:336.2pt; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top\"><p style=\"margin-top:1pt; margin-left:30.1pt; margin-bottom:4pt; text-indent:-30.1pt; text-align:justify; font-size:10pt\"><span style=\"font-family:Arial, sans-serif; font-style:italic\">Examples</span></p><p style=\"margin-top:4pt; margin-bottom:3pt; text-align:justify; font-size:10pt\"><span style=\"font-family:Arial, sans-serif\">Examples of jurisdictional grounds on which an employer may move for the dismissal of the application (see sections 170CBA, 170CC and subsection 170CE</span><span style=\"font-family:Arial, sans-serif\"> </span><span style=\"font-family:Arial, sans-serif\">(5A) </span><span style=\"font-family:Arial, sans-serif; font-style:italic\">Workplace Relations Act 1996</span><span style=\"font-family:Arial, sans-serif\"> are as follows:</span></p></td></tr><tr><td colspan=\"2\" style=\"width:336.2pt; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top\"><ul style=\"margin:0pt; padding-left:0pt\"><li style=\"margin-top:1pt; margin-left:27.6pt; margin-bottom:3pt; text-align:justify; padding-left:8.4pt; font-family:serif; font-size:10pt\"><span style=\"font-family:Arial, sans-serif\">The applicant had not completed the qualifying period of employment (see subsection 170CE</span><span style=\"font-family:Arial, sans-serif\"> </span><span style=\"font-family:Arial, sans-serif\">(5A)).</span></li></ul></td></tr><tr><td colspan=\"2\" style=\"width:336.2pt; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top\"><ul style=\"margin:0pt; padding-left:0pt\"><li style=\"margin-top:1pt; margin-left:27.6pt; margin-bottom:3pt; text-align:justify; padding-left:8.4pt; font-family:serif; font-size:10pt\"><span style=\"font-family:Arial, sans-serif\">The applicant was engaged under a contract of employment for a specified period of time (see paragraph 170CBA (1)</span><span style=\"font-family:Arial, sans-serif\"> </span><span style=\"font-family:Arial, sans-serif\">(a)).</span></li></ul></td></tr><tr><td colspan=\"2\" style=\"width:336.2pt; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top\"><ul style=\"margin:0pt; padding-left:0pt\"><li class=\"FootnoteText\" style=\"margin-top:1pt; margin-left:27.6pt; margin-bottom:3pt; text-align:justify; padding-left:8.4pt; font-family:serif\"><span style=\"font-family:Arial, sans-serif\">The applicant was engaged under a contract of employment for a specified task (see paragraph 170CBA</span><span style=\"font-family:Arial, sans-serif\"> </span><span style=\"font-family:Arial, sans-serif\">(1)</span><span style=\"font-family:Arial, sans-serif\"> </span><span style=\"font-family:Arial, sans-serif\">(b)).</span></li></ul></td></tr><tr><td colspan=\"2\" style=\"width:336.2pt; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top\"><ul style=\"margin:0pt; padding-left:0pt\"><li style=\"margin-left:27.6pt; text-align:justify; padding-left:8.4pt; font-family:serif; font-size:10pt\"><span style=\"font-family:Arial, sans-serif\">The applicant was serving a period of probation, the duration or maximum duration of which was determined in advance and was 3 months or less, or otherwise reasonable given the nature and circumstances of the employment (see paragraph 170CBA (1)</span><span style=\"font-family:Arial, sans-serif\"> </span><span style=\"font-family:Arial, sans-serif\">(c)).</span></li><li style=\"margin-right:0.3pt; margin-left:27.6pt; margin-bottom:3pt; padding-left:8.4pt; font-family:serif; font-size:10pt\"><span style=\"font-family:Arial, sans-serif\">The applicant was a casual employee engaged for a short period.</span></li></ul><p style=\"margin-top:3pt; margin-left:38.85pt; margin-bottom:3pt; page-break-after:avoid; font-size:10pt\"><span style=\"font-family:Arial, sans-serif\">A casual employee is taken to be engaged for a short period unless:</span></p><p style=\"margin-top:3pt; margin-left:38.85pt; margin-bottom:3pt; page-break-after:avoid; font-size:10pt\"><span style=\"font-family:Arial, sans-serif\">(a) (i)</span><span style=\"width:0pt; font-family:Arial, sans-serif; display:inline-block\"> </span><span style=\"font-family:Arial, sans-serif\">the employee is engaged by a particular employer on a regular and systematic basis for a sequence of periods of employment during a period of at least 12 months; or</span></p><p style=\"margin-top:3pt; margin-left:38.85pt; margin-bottom:3pt; text-align:justify; page-break-after:avoid; font-size:10pt\"><span style=\"font-family:Arial, sans-serif\"></span><span style=\"font-family:Arial, sans-serif\">(ii)</span><span style=\"width:0pt; font-family:Arial, sans-serif; display:inline-block\"> </span><span style=\"font-family:Arial, sans-serif\">the employee was engaged on a regular and systematic basis for a sequence of periods during a period of employment totalling at least 12 months but ceased to be so engaged, on the employer’s initiative, at the end of the first period of employment of less than 12 months, and then within 3 months after the end of the first period was engaged again for a further sequence of periods of employment; and</span></p><p style=\"margin-top:3pt; margin-left:38.85pt; margin-bottom:3pt; text-align:justify; page-break-after:avoid; font-size:10pt\"><span style=\"font-family:Arial, sans-serif\">(b) the employee has, or but for a decision by the employer to terminate the employee’s employment, would have had, a reasonable expectation of continuing employment by the employer.</span></p><p style=\"margin-top:3pt; margin-left:38.85pt; text-align:justify; page-break-after:avoid; font-size:10pt\"><span style=\"font-family:Arial, sans-serif\">(see paragraph 170CBA</span><span style=\"font-family:Arial, sans-serif\"> </span><span style=\"font-family:Arial, sans-serif\">(1)</span><span style=\"font-family:Arial, sans-serif\"> </span><span style=\"font-family:Arial, sans-serif\">(d), subsections 170CBA</span><span style=\"font-family:Arial, sans-serif\"> </span><span style=\"font-family:Arial, sans-serif\">(3) and (3A)).</span></p><p class=\"DefaultParagraphFont1\" style=\"font-size:10pt\"><span style=\"font-family:Arial, sans-serif\"></span></p></td></tr><tr><td colspan=\"2\" style=\"width:336.2pt; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top\"><ul style=\"margin:0pt; padding-left:0pt\"><li style=\"margin-right:1.7pt; margin-left:28.2pt; text-align:justify; padding-left:8.35pt; font-family:serif; font-size:10pt\"><span style=\"font-family:Arial, sans-serif\">The applicant was a trainee employed under a traineeship agreement or an approved traineeship for a specified period, or for the duration of the agreement (see paragraph 170CBA</span><span style=\"font-family:Arial, sans-serif\"> </span><span style=\"font-family:Arial, sans-serif\">(1)</span><span style=\"font-family:Arial, sans-serif\"> </span><span style=\"font-family:Arial, sans-serif\">(e)).</span></li></ul></td></tr><tr><td colspan=\"2\" style=\"width:336.2pt; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top\"><ul style=\"margin:0pt; padding-left:0pt\"><li style=\"margin:1pt 1.7pt 3pt 28.25pt; text-align:justify; padding-left:8.4pt; font-family:serif; font-size:10pt\"><span style=\"font-family:Arial, sans-serif\">The applicant was not employed under award conditions and the applicant’s annual remuneration immediately before termination exceeded a specified rate ($94</span><span style=\"font-family:Arial, sans-serif\"> </span><span style=\"font-family:Arial, sans-serif\">900, July 2005) (see paragraph 170CBA</span><span style=\"font-family:Arial, sans-serif\"> </span><span style=\"font-family:Arial, sans-serif\">(1)</span><span style=\"font-family:Arial, sans-serif\"> </span><span style=\"font-family:Arial, sans-serif\">(f)).</span></li></ul></td></tr><tr><td colspan=\"2\" style=\"width:336.2pt; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top\"><ul style=\"margin:0pt; padding-left:0pt\"><li style=\"margin:1pt 1.7pt 4pt 28.25pt; text-align:justify; padding-left:8.4pt; font-family:serif; font-size:10pt\"><span style=\"font-family:Arial, sans-serif\">The applicant is not covered by a federal award or agreement.</span></li></ul><p style=\"margin-top:4pt; margin-left:23pt; margin-bottom:3pt; text-align:justify; font-size:10pt\"><span style=\"font-family:Arial, sans-serif; font-style:italic\">(This may be a relevant objection only in NSW, Qld, WA, SA, Tas.</span><span style=\"font-family:Arial, sans-serif\"> </span><span style=\"font-family:Arial, sans-serif; font-style:italic\">This basis of objection is only applicable if the application is based on the ground that the termination was harsh, unjust or unreasonable.)</span></p></td></tr><tr><td colspan=\"2\" style=\"width:336.2pt; border-bottom:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top\"><ul style=\"margin:0pt; padding-left:0pt\"><li class=\"note0\" style=\"margin:1pt 1.7pt 4pt 29.35pt; text-align:justify; padding-left:8.4pt; font-family:serif; font-style:normal\"><span style=\"font-family:Arial, sans-serif\">The employer is not a constitutional corporation.</span></li></ul><p class=\"note0\" style=\"margin:4pt 1.7pt 3pt 23pt; text-indent:-23pt; text-align:justify\"><span style=\"width:23pt; text-indent:0pt; font-family:Arial, sans-serif; font-style:normal; display:inline-block\"></span><span style=\"font-family:Arial, sans-serif; font-style:normal\">(</span><span style=\"font-family:Arial, sans-serif\">This may be a relevant objection only in NSW, Qld, WA, SA, Tas. This ground of objection is applicable only if the application is based on the ground that the termination was harsh, unjust or unreasonable.)</span></p></td></tr><tr><td colspan=\"2\" style=\"width:336.2pt; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top; background-color:#f2f2f2\"><p style=\"margin-top:9pt; margin-right:14.2pt; margin-bottom:3pt; font-size:10pt\"><span style=\"font-family:Arial, sans-serif; font-weight:bold\">Declaration</span></p></td></tr><tr><td colspan=\"2\" style=\"width:336.2pt; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top\"><p style=\"margin-top:1pt; margin-left:1.7pt; margin-bottom:3pt; font-size:10pt\"><span style=\"font-family:Arial, sans-serif; font-weight:bold\">I declare that all the facts in this notice are correct and complete to the best of my knowledge and belief.</span></p></td></tr><tr><td rowspan=\"2\" style=\"width:109.8pt; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top\"><p style=\"margin-top:3pt; margin-right:1.7pt; page-break-inside:avoid; page-break-after:avoid; font-size:10pt\"><span style=\"font-family:Arial, sans-serif; font-style:italic\">The employer must sign this declaration unless the application was prepared by a solicitor, employer organisation or other representative of the employer.</span></p></td><td style=\"width:215.7pt; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top\"><p style=\"margin-right:1.7pt; page-break-inside:avoid; page-break-after:avoid; font-size:10pt\"><span style=\"font-family:Arial, sans-serif; font-style:italic\"></span></p><p style=\"margin-right:1.7pt; page-break-inside:avoid; page-break-after:avoid; font-size:10pt\"><span style=\"font-family:Arial, sans-serif; font-style:italic\"></span></p><p style=\"margin-right:1.7pt; page-break-inside:avoid; page-break-after:avoid; font-size:10pt\"><span style=\"font-family:Arial, sans-serif\">[</span><span style=\"font-family:Arial, sans-serif; font-style:italic\">signature of employer</span><span style=\"font-family:Arial, sans-serif\">]</span></p><p style=\"margin-right:1.75pt; page-break-inside:avoid; page-break-after:avoid; font-size:10pt\"><span style=\"font-family:Arial, sans-serif\"></span></p><p style=\"margin-right:1.7pt; margin-left:1.75pt; page-break-inside:avoid; page-break-after:avoid; font-size:10pt\"><span style=\"font-family:Arial, sans-serif\">Date / /</span></p></td></tr><tr><td style=\"width:215.7pt; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top\"><p class=\"BlockText\" style=\"margin-left:0pt; font-size:10pt\"><span style=\"font-family:Arial, sans-serif\"></span></p><p class=\"BlockText\" style=\"margin-top:6pt; margin-left:0pt; font-size:10pt\"><span style=\"font-family:Arial, sans-serif\"></span></p><p class=\"BlockText\" style=\"margin-top:6pt; margin-left:0pt; font-size:10pt\"><span style=\"font-family:Arial, sans-serif\">[</span><span style=\"font-family:Arial, sans-serif; font-style:italic\">signature of solicitor, employer organisation or other representative</span><span style=\"font-family:Arial, sans-serif\">]</span></p><p style=\"margin-top:6pt; margin-right:1.7pt; page-break-inside:avoid; page-break-after:avoid; font-size:10pt\"><span style=\"font-family:Arial, sans-serif\"></span></p><p style=\"margin-right:1.75pt; page-break-inside:avoid; page-break-after:avoid; font-size:10pt\"><span style=\"font-family:Arial, sans-serif\">Date / /</span></p></td></tr></tbody></table>\n```\n\nIf this notice was prepared by a legal practitioner, has a contingency fee agreement (see section 170CIA) been entered into? Yes  No \n\nIf this notice was prepared by a representative other than a legal practitioner, has a costs arrangement (see section 170CIA) been entered into? Yes  No \n\nNote This form must be lodged with the Commission within 7 days of receipt of the application (Form R18). Immediately after lodging the form, the employer must give a copy of the form to the applicant personally, or by post or facsimile transmission, at his or her address for service.\n\nPLEASE RETAIN A COPY OF THIS DOCUMENT FOR YOUR OWN RECORDS\n\nForm R21A Motion to dismiss the application for want of jurisdiction\n\n(rule 38)\n\n```html\n<table cellspacing=\"0\" cellpadding=\"0\" style=\"width:360.1pt; border-collapse:collapse\"><tbody><tr><td colspan=\"3\" rowspan=\"2\" style=\"width:214.4pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top\"><p class=\"Schedulepara\" style=\"margin-top:1pt; margin-left:0pt; margin-bottom:4pt; text-indent:0pt; text-align:left; page-break-after:avoid\"><span style=\"font-family:Arial, sans-serif; font-size:10pt\">Australian Industrial Relations Commission</span></p><p class=\"Schedulepara\" style=\"margin-top:4pt; margin-left:0pt; margin-bottom:4pt; text-indent:0pt; text-align:left; page-break-after:avoid\"><span style=\"font-family:Arial, sans-serif; font-size:10pt; font-weight:bold\">Motion to dismiss the application for want of jurisdiction</span></p><p class=\"Schedulepara\" style=\"margin-top:4pt; margin-left:0pt; margin-bottom:4pt; text-indent:0pt; text-align:left; page-break-after:avoid\"><span style=\"font-family:Arial, sans-serif; font-size:10pt; font-style:italic\">Workplace Relations Act 1996</span><span style=\"font-family:Arial, sans-serif; font-size:10pt\"> (Cwlth)</span></p><p class=\"Schedulepara\" style=\"margin-top:4pt; margin-left:0pt; margin-bottom:3pt; text-indent:0pt; text-align:left; page-break-after:avoid\"><span style=\"font-family:Arial, sans-serif; font-size:10pt\">Section 170CEA</span></p></td><td style=\"width:123.55pt; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top\"><p style=\"margin-bottom:1pt; font-size:11pt\"><span style=\"font-family:Arial, sans-serif\">Commission use only</span></p><p style=\"margin-top:1pt; margin-right:0.3pt; margin-bottom:4pt; font-size:10pt\"><span style=\"font-family:Arial, sans-serif\">File number:</span></p><p style=\"margin-top:4pt; margin-right:0.3pt; margin-bottom:3pt; font-size:10pt\"><span style=\"font-family:Arial, sans-serif; font-weight:bold\"></span></p></td></tr><tr><td style=\"width:123.55pt; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top\"><p style=\"margin-top:1pt; margin-right:0.15pt; margin-bottom:3pt; font-size:10pt\"><span style=\"font-family:Arial, sans-serif\">Date received:</span></p></td></tr><tr><td colspan=\"4\" style=\"width:348.65pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top\"><p style=\"margin-top:6pt; margin-bottom:6pt; font-size:11pt\"><span style=\"font-family:Arial, sans-serif; font-weight:bold\">Commission Case</span></p><p style=\"margin-top:6pt; margin-bottom:6pt; font-size:11pt\"><span style=\"font-family:Arial, sans-serif; font-weight:bold\">File Number U</span></p><p style=\"margin-top:6pt; text-align:center; font-size:11pt\"><span style=\"font-family:Arial, sans-serif; font-weight:bold\"></span></p></td></tr><tr><td colspan=\"4\" style=\"width:348.65pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top; background-color:#f2f2f2\"><p style=\"margin:9pt 14.2pt 3pt 1.7pt; page-break-after:avoid; font-size:10pt\"><span style=\"font-weight:bold\">Dismissal for want of jurisdiction</span></p><p style=\"margin:3pt 14.2pt 3pt 1.7pt; page-break-after:avoid; font-size:10pt\"><span style=\"font-style:italic\">Please place a tick or cross, where necessary, in the boxes below</span></p></td></tr><tr><td style=\"width:23pt; border-left:0.75pt solid #000000; padding-right:5.35pt; padding-left:4.97pt; vertical-align:top\"><p style=\"margin:1pt 14.15pt 3pt 1.7pt; font-size:10pt\"><span style=\"font-family:Wingdings, serif\"></span></p></td><td colspan=\"3\" style=\"width:314.95pt; border-right:0.75pt solid #000000; padding-right:4.97pt; padding-left:5.35pt; vertical-align:top\"><p style=\"margin-top:1pt; margin-right:1.75pt; margin-bottom:3pt; text-align:justify; font-size:10pt\"><span>The respondent moves for the dismissal of the application for want of jurisdiction before the matter is referred for conciliation; OR</span></p></td></tr><tr><td style=\"width:23pt; border-left:0.75pt solid #000000; padding-right:5.35pt; padding-left:4.97pt; vertical-align:top\"><p style=\"margin:1pt 14.15pt 3pt 1.7pt; font-size:10pt\"><span style=\"font-family:Wingdings, serif\"></span></p></td><td colspan=\"3\" style=\"width:314.95pt; border-right:0.75pt solid #000000; padding-right:4.97pt; padding-left:5.35pt; vertical-align:top\"><p style=\"margin-top:1pt; margin-right:1.75pt; margin-bottom:3pt; text-align:justify; font-size:10pt\"><span>The respondent moves for the dismissal of the application for want of jurisdiction but indicates that the motion may be dealt with after the matter is referred for conciliation; OR</span></p></td></tr><tr><td style=\"width:23pt; border-left:0.75pt solid #000000; padding-right:5.35pt; padding-left:4.97pt; vertical-align:top\"><p style=\"margin:1pt 14.15pt 3pt 1.7pt; font-size:10pt\"><span style=\"font-family:Wingdings, serif\"></span></p></td><td colspan=\"3\" style=\"width:314.95pt; border-right:0.75pt solid #000000; padding-right:4.97pt; padding-left:5.35pt; vertical-align:top\"><p style=\"margin-top:1pt; margin-right:1.75pt; margin-bottom:3pt; text-align:justify; font-size:10pt\"><span>The respondent moves (not having previously so moved) for the dismissal of the application for want of jurisdiction as conciliation has not resulted in settlement of this matter; OR</span></p></td></tr><tr><td style=\"width:23pt; border-left:0.75pt solid #000000; padding-right:5.35pt; padding-left:4.97pt; vertical-align:top\"><p style=\"margin:1pt 14.15pt 3pt 1.7pt; font-size:10pt\"><span style=\"font-family:Wingdings, serif\"></span></p></td><td colspan=\"3\" style=\"width:314.95pt; border-right:0.75pt solid #000000; padding-right:4.97pt; padding-left:5.35pt; vertical-align:top\"><p style=\"margin-top:1pt; margin-right:1.75pt; margin-bottom:3pt; text-align:justify; font-size:10pt\"><span>The respondent moves (having previously so moved) for the dismissal of the application for want of jurisdiction.</span></p></td></tr><tr><td colspan=\"4\" style=\"width:348.65pt; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top\"><p style=\"margin-top:1pt; margin-left:1.7pt; margin-bottom:6pt; text-align:justify; font-size:10pt\"><span>The respondent moves for the dismissal of the application on the following grounds:</span></p><p style=\"margin-top:6pt; margin-left:1.75pt; margin-bottom:3pt; text-align:justify; font-size:10pt\"><span style=\"font-weight:bold\"></span></p><p style=\"margin-top:3pt; margin-left:1.75pt; margin-bottom:3pt; text-align:justify; font-size:10pt\"><span style=\"font-weight:bold\"></span></p><p style=\"margin-top:3pt; margin-left:1.75pt; margin-bottom:3pt; text-align:justify; font-size:10pt\"><span style=\"font-weight:bold\"></span></p><p style=\"margin-top:3pt; margin-left:1.75pt; margin-bottom:3pt; text-align:justify; font-size:10pt\"><span style=\"font-weight:bold\"></span></p><p style=\"margin-top:3pt; margin-left:1.75pt; margin-bottom:1pt; text-align:justify; font-size:10pt\"><span style=\"font-weight:bold\"></span></p><p style=\"margin-top:1pt; margin-left:1.7pt; margin-bottom:6pt; text-align:justify; font-size:10pt\"><span style=\"font-style:italic\">Note</span><span style=\"font-style:italic\"> </span><span style=\"font-style:italic\"></span><span style=\"font-style:italic\"></span><span>See Form R21 for some examples of jurisdictional grounds on which an employer may move for the dismissal of the application.</span></p><p style=\"margin-top:6pt; margin-right:1.75pt; margin-bottom:3pt; text-align:justify; font-size:10pt\"><span>Documentation that will be relied on to substantiate the jurisdictional objection must accompany this Notice.</span></p></td></tr><tr><td colspan=\"4\" style=\"width:348.65pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top; background-color:#f2f2f2\"><p style=\"margin-top:9pt; margin-right:14.2pt; page-break-after:avoid; font-size:10pt\"><span style=\"font-weight:bold\">Declaration</span></p></td></tr><tr><td colspan=\"4\" style=\"width:348.65pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top\"><p style=\"margin-top:3pt; margin-left:1.7pt; margin-bottom:6pt; font-size:10pt\"><span style=\"font-weight:bold\">I declare that all the facts in this notice are correct and complete to the best of my knowledge and belief.</span></p><p style=\"margin-top:6pt; margin-left:1.7pt; margin-bottom:3pt; font-size:10pt\"><span></span></p></td></tr><tr><td colspan=\"2\" rowspan=\"2\" style=\"width:122.25pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top\"><p style=\"margin-top:3pt; margin-right:1.7pt; page-break-inside:avoid; page-break-after:avoid; font-size:10pt\"><span style=\"font-style:italic\">The respondent must sign this notice unless a solicitor, legal firm, employer organisation or other representative has prepared the notice.</span></p></td><td colspan=\"2\" style=\"width:215.7pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top\"><p style=\"margin-right:1.7pt; page-break-inside:avoid; page-break-after:avoid; font-size:10pt\"><span style=\"font-style:italic\"></span></p><p style=\"margin-right:1.7pt; page-break-inside:avoid; page-break-after:avoid; font-size:10pt\"><span style=\"font-style:italic\"></span></p><p style=\"margin-right:1.7pt; page-break-inside:avoid; page-break-after:avoid; font-size:10pt\"><span>[</span><span style=\"font-style:italic\">signature of respondent</span><span>]</span></p><p style=\"margin-right:1.75pt; page-break-inside:avoid; page-break-after:avoid; font-size:10pt\"><span></span></p><p style=\"margin-right:1.7pt; margin-left:1.75pt; page-break-inside:avoid; page-break-after:avoid; font-size:10pt\"><span>Date / /</span></p></td></tr><tr><td colspan=\"2\" style=\"width:215.7pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top\"><p class=\"BlockText\" style=\"margin-left:0pt; font-size:10pt\"><span style=\"font-family:Arial, sans-serif\"></span></p><p class=\"BlockText\" style=\"margin-top:6pt; margin-left:0pt; font-size:10pt\"><span style=\"font-family:Arial, sans-serif\"></span></p><p class=\"BlockText\" style=\"margin-top:6pt; margin-left:0pt; font-size:10pt\"><span>[</span><span style=\"font-style:italic\">signature of solicitor, legal firm, employer organisation or other representative</span><span>]</span></p><p style=\"margin-top:6pt; margin-right:1.7pt; page-break-inside:avoid; page-break-after:avoid; font-size:10pt\"><span></span></p><p style=\"margin-right:1.75pt; page-break-inside:avoid; page-break-after:avoid; font-size:10pt\"><span>Date / /</span></p></td></tr><tr style=\"height:0pt\"><td style=\"width:33.7pt\"></td><td style=\"width:99.25pt\"></td><td style=\"width:92.15pt\"></td><td style=\"width:134.25pt\"></td></tr></tbody></table>\n```\n\n> Note A motion to dismiss the application for want of jurisdiction is deemed to be made on the date of filing. Immediately after filing the motion, the employer must give a copy of the motion to the applicant personally, or by post or facsimile transmission, at his or her address for service.\n\nPLEASE RETAIN A COPY OF THIS DOCUMENT FOR YOUR OWN RECORDS\n\nForm R22 Notice of representative’s appearance\n\n(rule 39)\n\nWorkplace Relations Act 1996\n\n## AUSTRALIAN INDUSTRIAL RELATIONS COMMISSION\n\n## NOTICE OF REPRESENTATIVE’S APPEARANCE\n\n1. Title of Matter:\n\n............…………...................................................................................…………\n\nU No. ..............................................\n\n2. Name of solicitor or other representative entering appearance\\*/change  \nof appearance\\*\n\n………...................................................................................................…………\n\n3. Address for service of solicitor or representative\n\n........................................................................................................……….……..\n\n........................................................................................................……………...\n\n................................……….....…….............Facsimile:…....................………....\n\n4. Appearance is entered on behalf of applicant\\*/respondent\\*.\n\n5. I/We have been retained by the party under a costs arrangement or a contingency fee agreement  Yes  No\n\n6. Signature of solicitor or representative....…...……......................……….\n\n7. Date of this Notice ...............................………….…………….…….…...\n\n\\* Omit whichever is inapplicable.\n\n> Note Immediately after filing the notice, a copy must be given to the other party at his or her address for service either personally, or by post or facsimile transmission.\n\nForm R23 Notice of discontinuance\n\n(rule 43)\n\n    Workplace Relations Act 1996\n    AUSTRALIAN INDUSTRIAL RELATIONS COMMISSION\n\nNOTICE OF DISCONTINUANCE\n\nCommission Reference U ................................................................\n\nIn the matter of\n\n\\[name of employee\\]\n\nand\n\n\\[name of employer\\]\n\nThe Applicant\n\n\\*wholly discontinues this matter\n\n\\*wholly discontinues this matter as part of the terms of settlement agreed to.\n\nDated: .......................................................\n\nSigned: ......................................................................................\n\n\\[applicant/solicitor/union or other representative\\]\n\n\\* Omit whichever is inapplicable.\n\nNOTE: AFTER FILING THIS NOTICE IN THE INDUSTRIAL REGISTRY A COPY OF THIS NOTICE MUST BE GIVEN IMMEDIATELY TO THE EMPLOYER AT HIS OR HER ADDRESS FOR SERVICE EITHER PERSONALLY, BY POST OR FACSIMILE TRANSMISSION.\n\n| Commission use only:Date Received: |\n| ---------------------------------- |\n\nForm R24 Certificate under section 170CF\n\n(rule 44)\n\nWorkplace Relations Act 1996\n\n## AUSTRALIAN INDUSTRIAL RELATIONS COMMISSION\n\nCERTIFICATE STATING COMMISSION IS SATISFIED CONCILIATION UNSUCCESSFUL\n\n## (U No ..............................................)\n\n\\[name of member\\] \\[place and date\\]\n\nAn application for relief in respect of termination of employment has been lodged on the following ground or grounds:\n\n the termination was harsh, unjust or unreasonable\n\n an alleged contravention of section 170CK of the Act\n\n an alleged contravention of section 170CL of the Act\n\n an alleged contravention of section 170CM of the Act\n\n an alleged contravention of section 170CN of the Act\n\nIn accordance with subsection 170CF (2) of the Workplace Relations Act 1996, the Commission certifies that all reasonable attempts to settle the matter by conciliation have been, or are likely to be, unsuccessful in respect of the following ground or grounds:\n\n the termination was harsh, unjust or unreasonable\n\n an alleged contravention of section 170CK of the Act\n\n an alleged contravention of section 170CL of the Act\n\n an alleged contravention of section 170CM of the Act\n\n an alleged contravention of section 170CN of the Act\n\nAn assessment of the merits of the application has been indicated to the parties in the following terms:\n\n\\[set out terms of assessment\\]\n\nThe Commission recommends that the applicant not pursue the application\\*\n\nAND/OR\n\nHaving regard to all the material before the Commission, the Commission concludes under subsection 170CF (4) that the applicant has no reasonable prospect of success at arbitration in relation to the ground that the termination was harsh, unjust or unreasonable.\\]\\*\n\n\\* Omit if inapplicable\n\nBY THE COMMISSION:\n\n\\[Signature of member\\]\n\nMember’s Title\n\n> Note The applicant has 7 days from the date of this certificate within which to lodge a notice of election.","sortOrder":4},{"sectionNumber":"NOTICE OF REPRESENTATIVE’S APPEARANCE","sectionType":"schedule","heading":"NOTICE OF REPRESENTATIVE’S APPEARANCE","content":"## NOTICE OF REPRESENTATIVE’S APPEARANCE\n\n1. Title of Matter:\n\n............…………...................................................................................…………\n\nU No. ..............................................\n\n2. Name of solicitor or other representative entering appearance\\*/change  \nof appearance\\*\n\n………...................................................................................................…………\n\n3. Address for service of solicitor or representative\n\n........................................................................................................……….……..\n\n........................................................................................................……………...\n\n................................……….....…….............Facsimile:…....................………....\n\n4. Appearance is entered on behalf of applicant\\*/respondent\\*.\n\n5. I/We have been retained by the party under a costs arrangement or a contingency fee agreement  Yes  No\n\n6. Signature of solicitor or representative....…...……......................……….\n\n7. Date of this Notice ...............................………….…………….…….…...\n\n\\* Omit whichever is inapplicable.\n\n> Note Immediately after filing the notice, a copy must be given to the other party at his or her address for service either personally, or by post or facsimile transmission.\n\nForm R23 Notice of discontinuance\n\n(rule 43)\n\n    Workplace Relations Act 1996\n    AUSTRALIAN INDUSTRIAL RELATIONS COMMISSION\n\nNOTICE OF DISCONTINUANCE\n\nCommission Reference U ................................................................\n\nIn the matter of\n\n\\[name of employee\\]\n\nand\n\n\\[name of employer\\]\n\nThe Applicant\n\n\\*wholly discontinues this matter\n\n\\*wholly discontinues this matter as part of the terms of settlement agreed to.\n\nDated: .......................................................\n\nSigned: ......................................................................................\n\n\\[applicant/solicitor/union or other representative\\]\n\n\\* Omit whichever is inapplicable.\n\nNOTE: AFTER FILING THIS NOTICE IN THE INDUSTRIAL REGISTRY A COPY OF THIS NOTICE MUST BE GIVEN IMMEDIATELY TO THE EMPLOYER AT HIS OR HER ADDRESS FOR SERVICE EITHER PERSONALLY, BY POST OR FACSIMILE TRANSMISSION.\n\n| Commission use only:Date Received: |\n| ---------------------------------- |\n\nForm R24 Certificate under section 170CF\n\n(rule 44)","sortOrder":5},{"sectionNumber":"(U No ..................................","sectionType":"schedule","heading":"(U No ..............................................)","content":"## (U No ..............................................)\n\n\\[name of member\\] \\[place and date\\]\n\nAn application for relief in respect of termination of employment has been lodged on the following ground or grounds:\n\n the termination was harsh, unjust or unreasonable\n\n an alleged contravention of section 170CK of the Act\n\n an alleged contravention of section 170CL of the Act\n\n an alleged contravention of section 170CM of the Act\n\n an alleged contravention of section 170CN of the Act\n\nIn accordance with subsection 170CF (2) of the Workplace Relations Act 1996, the Commission certifies that all reasonable attempts to settle the matter by conciliation have been, or are likely to be, unsuccessful in respect of the following ground or grounds:\n\n the termination was harsh, unjust or unreasonable\n\n an alleged contravention of section 170CK of the Act\n\n an alleged contravention of section 170CL of the Act\n\n an alleged contravention of section 170CM of the Act\n\n an alleged contravention of section 170CN of the Act\n\nAn assessment of the merits of the application has been indicated to the parties in the following terms:\n\n\\[set out terms of assessment\\]\n\nThe Commission recommends that the applicant not pursue the application\\*\n\nAND/OR\n\nHaving regard to all the material before the Commission, the Commission concludes under subsection 170CF (4) that the applicant has no reasonable prospect of success at arbitration in relation to the ground that the termination was harsh, unjust or unreasonable.\\]\\*\n\n\\* Omit if inapplicable\n\nBY THE COMMISSION:\n\n\\[Signature of member\\]\n\nMember’s Title\n\n> Note The applicant has 7 days from the date of this certificate within which to lodge a notice of election.","sortOrder":7},{"sectionNumber":"Part 1","sectionType":"part","heading":"About the single business","content":"## Part 1: About the single business","sortOrder":8},{"sectionNumber":"Part 2","sectionType":"part","heading":"About the Jurisdictional Basis of the application","content":"## Part 2: About the Jurisdictional Basis of the application","sortOrder":9},{"sectionNumber":"Part 3","sectionType":"part","heading":"About the Employer(s) party to the agreement","content":"## Part 3: About the Employer(s) party to the agreement","sortOrder":10},{"sectionNumber":"Part 4","sectionType":"part","heading":"About the Employee Organisation(s) party to the Agreement","content":"## Part 4: About the Employee Organisation(s) party to the Agreement","sortOrder":11},{"sectionNumber":"Part 5","sectionType":"part","heading":"Involvement of Employee Organisations","content":"## Part 5: Involvement of Employee Organisations","sortOrder":12},{"sectionNumber":"Part 6","sectionType":"part","heading":"About the Employees","content":"## Part 6: About the Employees","sortOrder":13},{"sectionNumber":"Part 7","sectionType":"part","heading":"About the Agreement","content":"## Part 7: About the Agreement","sortOrder":14},{"sectionNumber":"Schedule of","sectionType":"schedule","heading":"terms to be varied","content":"## Schedule of terms to be varied\n\nPrint Number\n\n| Award Code& Var No | Clause No | Substance of variation | Date of Effect |\n| ------------------ | --------- | ---------------------- | -------------- |\n|                    |           |                        |                |\n|                    |           |                        |                |\n\nDated\n\n\\[Signature\\]\n\nRegistrar\n\n> Note The prescribed time for lodging an objection to a variation is 28 days after the publication of this notice.\n\nForm R60A Notice of objection to variation of a common rule\n\n(rule 65)\n\nWorkplace Relations Act 1996\n\nAUSTRALIAN INDUSTRIAL RELATIONS COMMISSION\n\nIN the matter of:\n\n\\[insert title of award and case number\\]\n\nAND in the matter of an application to vary the above award \\[or part thereof\\].\n\nNotice is given by \\[insert name of organisation or person interested\\] of objection to the variation binding \\[name of organisation or person interested\\].\n\nThe grounds on which this objection is made are as follows:\n\n\\[Set out in numbered paragraphs the grounds of objection\\].\n\nDated\n\n.........................................\n\nSignature\n\n> Note The prescribed time for lodging an objection to a variation is 28 days after the publication of this notice.","sortOrder":26}],"analysis":{"kimi_summary":{"_metrics":{"model":"kimi-k2.5","source":"moonshot-realtime","completionTokens":3442},"content_quality":"ok","complexity_score":6,"scope_assessment":{"changed":false,"description":"The content provided represents the original 1998 procedural framework without evidence of subsequent expansion. The scope remains focused on termination of employment dispute resolution and award/agreement procedures as originally enacted."},"complexity_factors":["Multiple cross-references to specific sections of the Workplace Relations Act 1996 (ss 170CE, 170CK, 170CL, 170CM, 170CN, 170CF)","Conditional branching logic within forms (e.g., 'if yes go to item 9, if no go to item 11')","Numerous jurisdictional exclusions and exceptions (casual employees, probationary periods, specified task contracts, trainees, high-income earners over $94,900)","Strict procedural time limits creating jurisdictional bars (21-day application limit, 7-day employer response, 7-day election period after conciliation fails)","Duplicated content in the source text (Forms R22, R23 and R24 appear twice)","HTML markup artifacts and fragmented section headings indicating incomplete reproduction of the full Rules","Multiple distinct grounds for termination claims requiring specific election (harsh/unjust/unreasonable vs. statutory contraventions)"],"plain_english_summary":"This document sets out the procedural rules and prescribed forms used by the Australian Industrial Relations Commission (AIRC) in 1998 to handle disputes about unfair dismissal and termination of employment under the *Workplace Relations Act 1996*.\n\n**What it does:**\n- **Forms for employees:** Provides Form R19 (for claims about mass redundancies without proper notice under section 170CL) and Form R20 (for claims about unfair dismissal, harsh treatment, or other unlawful termination grounds under sections 170CK, 170CM, and 170CN).\n- **Employer response:** Requires employers to lodge Form R21 within 7 days, giving their side of the story and raising any jurisdictional objections (such as claiming the employee was a casual, on probation, or not covered by federal law).\n- **Jurisdictional challenges:** Allows employers to file Form R21A to dismiss applications that fall outside the Commission's power (for example, if the employee hadn't worked the qualifying period or earned above the high-income threshold).\n- **Representation and procedure:** Covers how parties appoint representatives (Form R22), discontinue matters (Form R23), and how the Commission issues certificates when conciliation fails (Form R24), allowing the matter to proceed to arbitration.\n- **Award variations:** Includes Form R60A for objecting to changes to industrial awards (common rule variations).\n\n**Who it affects:**\nEmployees and employers operating under federal industrial relations laws in 1998, specifically those covered by federal awards or agreements seeking to challenge terminations or negotiate agreements.\n\n**Key requirements:**\n- **Strict deadlines:** Employees had to apply within 21 days of termination (late applications only accepted if the Commission deemed it \"unfair\" to refuse them). Employers had 7 days to respond.\n- **Fees:** A $52.40 lodgment fee applied unless waived by a Registrar.\n- **Conciliation first:** Parties had to attempt conciliation (mediation) before a formal hearing could occur.\n\n**Why it matters:**\nThese rules governed the federal unfair dismissal system and enterprise agreement procedures prior to the 2009 *Fair Work Act*, which abolished the AIRC and replaced it with the Fair Work Commission."},"flash_summary":{"complexity_score":7,"scope_assessment":{"changed":false,"description":"The material supplied sets out procedural forms, filing requirements, and administrative steps to implement the termination-of-employment provisions of the Workplace Relations Act 1996. It prescribes how claims are lodged, fees paid, notices served, jurisdictional objections made, and conciliation certificates issued. The documents operate at the procedural level and do not, in themselves, alter the substantive scope of the statutory termination provisions; they implement and give effect to procedural gateways and timeframes already referenced in the Act (see s 170CL text and the repeated statutory citations on the forms)."},"complexity_factors":["Large set of interlocking standard forms (R19–R24, R21, R21A, R22, R23, R60A) with distinct filing and service requirements","Multiple statutory references and cross‑references (s 170CL, 170CE/170CEAA, 170CF, 170CJ, 170CBA, 170CC, 170CE(5A), 170CIA) that determine different procedural rights and gateways","Strict and varied time limits (21 days for lodging applications; 7 days for employer appearance; deemed filing dates for motions) creating tight procedural windows","Fee payment and waiver mechanism (s 170CEAA) plus refund rules increase administrative steps","Requirement to attach documentary evidence for jurisdictional objections (burden on employer early in the process)","Commission discretion points (accepting late lodgment, ordering costs, certifying conciliation unsuccessful) that introduce legal uncertainty","Overlap between conciliation and arbitration steps and the potential for early dismissal on jurisdictional grounds increases procedural strategic complexity"],"plain_english_summary":"What these rules do (mechanics)\n\n- Set out the standard forms and procedural steps the Australian Industrial Relations Commission (the Commission) uses when an employee, or a union on an employee’s behalf, applies for relief about a termination of employment under the Workplace Relations Act 1996. The relevant statutory hooks referred to in the forms include sections 170CL, 170CK, 170CM, 170CN, 170CE, 170CEAA, 170CF, 170CJ and related jurisdictional provisions (see the text of the forms and the extract of section 170CL included in the materials).\n\n- Require certain information to be provided on standard forms: the identity and contact details of employer and employee(s), the date the employee was given notice of the decision to terminate, the award or agreement under which the employee was employed, a short summary of the reasons given for the termination, whether a union or representative acts for the applicant, and particulars of any costs or contingency arrangements (see Forms R19–R24, R21A, R22, R23, R60A).\n\n- Prescribe time and service rules: an employee must generally lodge an application within 21 days of being given notice of the termination; if lodged after 21 days the Commission must decide whether to accept the late lodgment (Forms R19/R20 item on extension of time). An employer who intends to appear must file a Notice of Employer’s Appearance within 7 days of receipt of the application and must give the applicant a copy immediately after lodging (Form R21).\n\n- Require a lodgment fee to be paid on filing most termination applications: the forms state a fee of $52.40 is payable on lodgment under section 170CEAA unless a Registrar waives it; the forms also set out payment methods and note the fee can be refundable in certain circumstances (Forms R19, R20; see s 170CEAA reference on the forms).\n\n- Provide a process for employer jurisdictional objections: an employer may move to dismiss an application for want of jurisdiction using Form R21A. The motion is treated as made on the date of filing and must be served on the applicant immediately; documentation relied on to substantiate the jurisdictional objection must accompany the motion (Form R21A and related instructions). The forms list common jurisdictional grounds the employer may assert (for example: qualifying period not completed; specified-term or specified-task contract; short-term casual; probationary engagement; traineeship; or remuneration above a specified federal threshold) (see Form R21 / R21A text referring to sections 170CBA, 170CC and subsection 170CE(5A)).\n\n- Provide conciliation/arbitration steps and certification: if conciliation is attempted and found unsuccessful the Commission may issue a certificate under section 170CF (Form R24). That certificate may also include an indicated assessment of the merits and can trigger the applicant’s 7‑day right to lodge a notice of election (Form R24 / s 170CF references in the form).\n\n- Provide forms for related procedural steps: notice of representative’s appearance (Form R22), notice of discontinuance (Form R23), and notice of objection to award variation (Form R60A), each with their own lodgment and service instructions (Forms R22, R23, R60A).\n\nWho this affects and who pays\n\n- Primary affected parties: employees who allege wrongful termination under the specified parts of the Workplace Relations Act 1996, unions acting for employees, and employers who must respond to applications and who may need to file notices or raise jurisdictional objections (Forms R19–R24, R21A). \n\n- Who pays: the applicant (employee or union filing) is required to pay a $52.40 lodgment fee on filing an application (Form R19 / s 170CEAA reference). The forms also record that, in some cases, the Commission may order costs (s 170CJ is referenced in the forms as allowing costs orders). Employers and applicants bear the costs of preparing filings, serving documents, and any legal or representative fees (Forms R21, R21A, R22).\n\nBehavior the rules create or change (incentives and obligations)\n\n- Employers deciding to terminate 15 or more employees for economic/technological/structural-type reasons must give written notice of intended terminations to the prescribed body or the Secretary of the Department in the form prescribed by regulation and set out the reasons, numbers/categories affected and timing; and subsection (3) of the included section 170CL text prohibits termination under the decision unless the employer has complied with the notice requirement (see printed text of s 170CL in the material). That creates a legal precondition employers must follow before effecting mass terminations in the circumstances described.\n\n- Applicants face tight time limits and a filing fee. Filing late triggers a Commission discretion to accept or refuse late lodgment; applicants must state reasons for seeking an extension (Form R19 item 7). This creates an incentive to lodge promptly and a procedural barrier if delayed.\n\n- Employers are prompted to move early on jurisdictional points: Form R21A makes a motion to dismiss for want of jurisdiction a discrete, early step and requires supporting documentation. The form notes specific statutory jurisdictional grounds (see references to s 170CBA, s 170CC and subsection 170CE(5A)). The motion is deemed made on filing, and must be served to the other party immediately.\n\nCompliance burden and operational costs\n\n- Administrative compliance: completion and accurate lodgment of standard forms, payment of the lodgment fee, and prompt service of notices (applicants must provide particulars; employers must file appearance notices within 7 days and serve copies; motions and certificates must be served immediately after filing — see Forms R21, R21A, R24). These requirements create routine administrative work for employers, unions and employees.\n\n- Evidence and documentation: an employer filing a jurisdictional objection must accompany the motion with documentation to substantiate the objection (Form R21A). Preparation of factual material and legal submissions will typically involve legal or representative costs.\n\n- Potential for costs orders: the forms explicitly warn about section 170CJ which allows the Commission, in certain circumstances, to order costs against a party (forms cite s 170CJ). That introduces a financial risk to tactical or unmeritorious filings.\n\nBureaucratic discretion and decision points\n\n- Commission discretion over late lodgments: the forms make clear that if an application is lodged more than 21 days after the notice of decision to terminate, the Commission must decide whether accepting it would be unfair not to do so (Form R19 / note regarding 21 days). That is an explicit discretionary gate.\n\n- Commission role in conciliation and certification: the Commission can certify conciliation as unsuccessful and indicate an assessment of merits; it may recommend that an applicant not pursue the application and can state it considers the applicant has no reasonable prospect of success (Form R24 referencing s 170CF). These certificates affect whether a matter proceeds to arbitration.\n\n- Registrar discretion on fee waivers: the forms note that the Registrar may approve waiving the lodgment fee (Form R19 / s 170CEAA reference).\n\nEffects on private choice and enterprise (source‑grounded observations)\n\n- Managers’ contractual freedom to terminate is constrained procedurally in at least two ways: (1) where s 170CL applies a statutory precondition (notice to prescribed body/Secretary and content requirement) must be met before certain multi‑employee terminations; and (2) potential exposure to Commission proceedings (and costs) gives employers an incentive to follow procedural steps carefully (text of s 170CL as included; Forms R19/R21/R21A). The material does not create or quantify substantive compensation entitlements here; it sets procedural pathways.\n\n- Small but definite transactional costs arise for all parties: the lodgment fee, administrative time to complete forms and to serve documents, and the likely need for legal or union representation in contested matters (Forms R19–R24, R21A, R22). The Commission’s capacity to order costs means parties internalise some of the litigation risk (forms cite s 170CJ).\n\nTrade‑offs, implementation risk and opportunities for error\n\n- Trade‑offs: quicker access to a Commission remedy is balanced against strict procedural time limits and evidentiary requirements. Late lodgments may be refused unless the Commission exercises discretion; jurisdictional objections can truncate matters quickly if successful (Forms R19 item 7; Forms R21/R21A). \n\n- Implementation risks: omissions or errors on standard forms, late service, or failure to pay or document the lodgment fee can create procedural bars (the forms repeatedly stress service and timing obligations, and the fee requirement under s 170CEAA). \n\n- Burden of proof for jurisdictional objections: the employer must accompany a jurisdictional motion with documentation (Form R21A), which shifts practical burdens onto employers to assemble factual/contractual material early in the process.\n\nConcentrated beneficiaries and costs (source‑grounded)\n\n- Concentrated beneficiaries: unions and individual employees who use the process to challenge terminations gain a defined, procedural route (Forms R19/R20). Employers incur concentrated compliance costs in preparing notices and in dealing with motions.\n\n- Diffuse costs: administrative burden across the registry and the need to process forms and certificates are implied by the number of prescribed forms and filing steps (many distinct forms: R19–R24, R21A, R22, R23, R60A).\n\nPrimary statutory references in the material\n\n- Notice and precondition for mass terminations: text of section 170CL appears in the material and explains the employer notice requirement and the prohibition on terminating unless subsection (2) is complied with (text of s 170CL included in the forms).\n\n- Fee: s 170CEAA is repeatedly cited on forms as the basis for a $52.40 lodgment fee unless waived by a Registrar (Forms R19, R20).\n\n- Costs: section 170CJ is mentioned on the forms as enabling costs orders in certain circumstances (Forms R19, R20).\n\n- Jurisdictional bases and examples: forms refer to jurisdictional provisions (s 170CBA, s 170CC and subsection 170CE(5A)) and give examples such as qualifying period, specified-term or specified-task contracts, short-term casuals, probation, traineeships, high-remuneration employees and constitutional corporation status as possible grounds for want-of-jurisdiction motions (Form R21 / R21A text).\n\nPractical takeaway (what parties will actually do)\n\n- Employees/unions: complete and lodge the relevant form (R19 or R20) promptly, pay the lodgment fee or seek a waiver, attach reasons and any supporting documents, and be prepared for conciliation; if a Form R24 certificate is issued they have 7 days to elect arbitration.\n\n- Employers: check the application on receipt, file Form R21 within 7 days and serve the applicant, decide whether to run a jurisdictional objection (Form R21A) with supporting documentation, and be mindful of potential costs orders and the requirement to follow the notice rule for large-scale terminations (s 170CL).\n\nThis summary describes the procedural framework and practical obligations the supplied forms create; it does not expand or restate substantive statutory rights beyond the operation of those forms and the brief extract of s 170CL included in the supplied material."}},"importantCases":[],"_links":{"self":"/api/acts/australian-industrial-relations-commission-rules-1998","history":"/api/acts/australian-industrial-relations-commission-rules-1998/history","analysis":"/api/acts/australian-industrial-relations-commission-rules-1998/analysis","conflicts":"/api/acts/australian-industrial-relations-commission-rules-1998/conflicts","importantCases":"/api/acts/australian-industrial-relations-commission-rules-1998/important-cases","documents":"/api/acts/australian-industrial-relations-commission-rules-1998/documents"}}